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Irish Association for Counselling and Psychotherapy for the Self Compassion formerly formerly with compassion”

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Integration of Theory and Practice Integration of A Profound and Complex Process Complex Process and A Profound Grief – A Journey through Non-Death Loss and Grief Grief – Perinatal Love, Hate & Health Professionals a Journ The Irish The • • • •

Volume 20 • Issue 3 • Autumn 2020 Volume 20 • Issue 3 • Autumn 2020 IJCP

From the Editor:

whatever form was needed, but never assuming that it was not required. In the next article on perinatal loss, Cathy Quinn emphasises the necessity for all practitioners to be fully aware of the multiple facets of such a loss, whilst recognising that each parent will have a different approach to their grief, that is unique to them. The writer offers a message of hope though, that by working with parents who suffer such a loss, in an empathetic, non-judgemental way, they have the space to grieve Dear Colleagues, be concerned for the welfare of and then they can learn to rebuild others, possibly to the detriment their lives in a meaningful way A very warm welcome to the of ourselves. With this in mind, without their baby. Autumn edition of the IJCP, after the theme of this edition of the In the final article, Mary Spring months of what has been a very IJCP is managing self-care for both reflects on how therapists challenging time, for all of us ourselves and our clients through can offer that safe place for and our clients. It has been a loss and bereavement. clients to mourn their present period of adjustment, accepting In our first article, Dr. Coleen and sometimes their past alternative ways to live and work Jones draws on her years of bereavements. However, she for our own safety, but for that experience to address the highlights the need for us to be of others too. We have had to importance of our self-care cognisant of the phenomenon undertake different methods to through the use of Winnicott’s of bereavement and loss and support our clients and accept wisdom and warns of the the different models available if they did not wish to proceed consequences when we let it to help clients. She also points with the alternative methods of slip or ignore the warning signs. out that we should explore our counselling. This left us holding Her piece is insightful and is a own experiences of bereavement them within our psyche, making timely reminder to us all in the and loss to ensure we have the contact to let them know that profession in the current climate. capacity to share our clients’ we had not forgotten them and The second article is based journey, so that as Mary writes, hoping this was enough to support on research carried out by Amy “a journey of two connecting them. For many therapists, this Sweetman and Dr. Siobáin hearts, the listening heart of the period has meant we have faced O’Donnell on non-death loss client and the bereaved heart of the challenges of adjusting to and grief and the effect of such the client.” Thus, really supporting different ways of practice and losses on psychotherapists. Their clients as they learn to cope with questioning if was this enough findings illustrate how those their loss. for those clients who were willing therapists’ emotions manifested On behalf of the editorial board to engage. This leads to the psychologically, cognitively, of the IJCP may I sincerely thank question: How have we been physically and behaviourally all the contributors to this edition looking after ourselves and and led onto their participants of the journal, especially during meeting our needs? experiencing a multitude of this present climate. Best wishes In the words of Thich Nhat Hahn, secondary losses. They looked to all of our readers in their “When we restore peace within at how these individuals found pursuits over the coming months ourselves, we have a chance to ways to cope and work through and may you all stay safe. restore peace within others”. As their losses, thus emphasizing the counsellors we are hardwired to importance of seeking support in Annette Murphy MIACP

Irish Association for Counselling and Psychotherapy 3 IJCP Volume 20 • Issue 3 • Autumn 2020

Contents

From the Editor 3 Our Title In Autumn 2017, our title changed Love, Hate & Health Professionals 4 from “Éisteach” to “The Irish Journal of Counselling and Psychotherapy” By Dr Coleen Jones or “IJCP” for short.

Non-Death Loss and Grief 8 Disclaimer: By Amy Sweetman and Dr Siobáin O’Donnell The views expressed in this publication, save where otherwise Perinatal Grief - A Profound and Complex Process 14 indicated, are the views of By Cathy Quinn contributors and not necessarily the views of the Irish Association for A Journey through Grief – Integration of Theory and Practice 20 Counselling and Psychotherapy. The By Mary Spring appearance of an advertisement in this publication does not necessarily Noticeboard 25 indicate approval by the Irish Association for Counselling and Psychotherapy for the product or service advertised.

Next Issue: 1st December 2020

Deadline for Advertising Submissions for Next Issue: 1st November 2020 For more information regarding advertising please contact Hugh O’Donoghue, Communications and Media Officer by email: [email protected] Editorial Board: or by phone: (01) 214 79 33 Mike Hackett (Chair), Cóilín Ó Braonáin, Hugh Morley, Maureen McKay Redmond, Kaylene Petersen (Assistant Editor), Annette Murphy (Editor), Scripts: Terry Naughton, Lynne Caffrey. Each issue of IJCP is planned well in Design and layout: advance of the publication date and GKD.ie some issues are themed. If you are interested in submitting an article ISSN: for consideration, responding to 2565-540X the Therapist’s Dilemma or wish to Advertising rates and deadlines: contribute a book or workshop review Contact the IACP for details. (Early booking essential) or Letter to the Editor, please see ‘Guidelines for Submitting Articles’ © Irish Association for Counselling and Psychotherapy – IACP on the IACP website, www.iacp.ie. All rights reserved. No part of this publication may be reproduced, stored in, or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, Contacting IJCP: photocopying, recording, or otherwise), except for brief referenced extracts for the purpose [email protected] of review, without the prior written permission of the copyright owners.

Irish Association for Counselling and Psychotherapy IJCP Volume 20 • Issue 3 • Autumn 2020

Practitioner Perspective Love, Hate & Health Professionals

By Dr Coleen Jones

and their patients as ‘clients’. This discussion is about the shadow side of ‘caring’. Often it is a simple misunderstanding of what ‘caring’ really means. It is a misunderstanding of how the mental state of seriously ill and troubled clients impacts on the well-being of the therapist. We live in a Western world purporting charitable, philanthropic and altruistic intentions in relation to others. This is a denial of the full range of emotions contained within our palette; both love and hate are present, and they are essential to our work. We need to have access to our fullness of being. It is my belief that we concern ourselves t present we are confronted by a world-wide with understanding both love and pandemic, which has placed psychotherapists and hate, generically speaking. A We are not living in the realm of other healthcare professionals in a most challenging rainbows and unicorns when we and demanding situation. The current situation often magically work with seriously ill or requires more of caring professionals than what they troubled clients, but rather face the blood and guts of turbulent are effectively able to give. In one way this quarantine emotions. There is no place for period is a creative void, allowing some individuals to sentimentality. It is dangerous rest and reflect, while others are stretched to breaking for both therapist and client, and in excess can lead to death. point. This means understanding what thoughts and emotions get stirred have worked for over 44 years the 'mental health' services. My up in the therapist by the client; I in the field of psychology, own training in psychodynamic thoughts and emotions which are counselling and psychotherapy. psychotherapy has alerted me often denied. Mostly the hour goes Half that time again I have worked to the implications of caring - by pleasantly and swiftly. It is the training therapists at university caring too much and caring too longer-term impact of the work that postgraduate level. I currently little – often at the expense needs to be understood. supervise the work of 'caring' of the counsellor, therapist, For this reason, I am turning professionals in a wide range of social-worker, psychiatrist inter to the seminal paper written by disciplines. What concerns me alia losing their life, sometimes Donald Winnicott called “Hate now is the extent of burnout, loss through suicide. Let me refer in the Countertransference” of life and the tragedy of suicide generically to all ‘caring’ (1947, p. 194). If you are in a wide range of professionals professionals in all disciplines reading this for the first time, working under the umbrella of in this article as ‘therapists’ please consider making a copy

4 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP for every professional whom you unless the relationship is totally know including your GP as it may t is important that the confidential, well-grounded and save lives. It is equally useful to Itherapist is in touch the supervisor, a person who parents and practitioners. with and has worked has attended to their own old Following the atrocities through issues relating to wounds. According to Winnicott it committed during the 20th century his/her own sexuality, as is not possible to be exclusively particularly the second world war, it will probably be acted nice and loving in relation to the we have turned towards being work, in relation to others and 'nice' to others. When what we out in some or other way in relation to clients. The 'nice' really need is to be 'real' and clients might stir up envy when grounded as parents, workers and wounded healer' (CW16, par 422) they finish therapy/treatment carers. Significantly, Winnicott archetype comes to mind. We and leave the therapist who is writes this paper immediately may be trying to fix ourselves, by now tired and drained. A bit after the war as a powerful fix a cold mother relationship or like the parent who sees their 20 reminder. When Winnicott talks attend to our unmet childhood year-old bouncing out the door on of 'love' he is talking generically needs. We need to establish a Friday night for a night of fun, of those feelings of compassion, a safe space and a secure pleasure and sex, with money in admiration, fondness and liking, relationship where reactions that their pocket, while the parent is we mostly have towards our are evoked in working with clients left tired and drained after a week clients. While 'hate' generically can be processed. How we feel at work providing the backup and includes a range of emotions such in response to what the troubled where-withal for that pleasure; as irritation, loathing, weariness, client brings us is called the note that the envy and resentment envy or even pure hate. How does countertransference. Winnicott is denied and hidden under the the therapist feel when the client writes that the therapist must: guise of generosity - “we were arrives late, forgets appointments like that once”. In the case of the or does not pay them, but then “be so thoroughly aware of the ‘not so nice’ client, the therapist arrives hungover or flaunting all countertransference that he can mostly hides the fact that they are recommendations relating to his/ sort out and study his objective overjoyed when the client does her health and wellbeing Winnicott reactions to the patient.” (1947, not show up or leaves therapy. says: p. 194) The therapist may avoid the task of contacting or “grasping the “the analyst’s own hate [needs Donald Winnicott was a thorny nettle” and working through to be] extremely well sorted out paediatrician for most of his difficult issues with the client. It is and conscious…however much life and therefore worked with perplexing, for example, when the he loves his patients he cannot children who were sick rather therapist feels sexually aroused avoid hating them and fearing than troubled. He had a deep by the client and is pulled into them, and the better he knows understanding of normalcy and a confusing erotic transference. this the less will hate and fear play. It is the idea of creative play The therapist might feel mortified be the motives determining what occurring in process supervision to express and work through this he does to his patients.” (1947. and in the therapeutic space. reaction with anyone else, but a p. 194) Supervision which follows is private and trusted supervisor. the essential engagement. The In the supervisory space the Therapists have their own space where clarity emerges, therapist can begin to understand unresolved, developmental issues where the therapist can express that the client is probably acting which are mostly repressed and/ and understand why she feels out, acting seductively as a way of or only briefly touched on in irritated by a client who displays avoiding his/her early childhood training; mostly because they grandiosity and eschews the need pain and confusion. It is important think they have been drawn to for therapy and who may even that the therapist is in touch with the work in order to 'help' others. imply that it is the therapist who and has worked through issues In fact, we are drawn to the needs the therapy more! The relating to his/her own sexuality, work because we, sometimes, supervisory space is very delicate as it will probably be acted out in have our own deep unresolved though. It can take us into deep, some or other way. We may now issues. Jung’s idea of 'the old wounds and can be exposing understand how teachers and

Irish Association for Counselling and Psychotherapy 5 IJCP Volume 20 • Issue 3 • Autumn 2020 coaches etc have strayed over what I call acts of commission, this line. hat my experience to use a legal term, in other Ambivalence is the experience Whas shown me is words trauma; bad things done of simultaneous and contradictory the fact that in most to them. He also refers to clients attitudes or feelings (such institutions, supervision who missed out on experiences as attraction and repulsion) degenerates into case iii) what I call acts of omission. toward an object, person, or management This means that these clients action. According to Winnicott are unconscious and do not the neurotic client experiences know what they don’t know and ambivalence as an either/or lighting a match in an old coal don’t know what they are missing phenomenon and experiences the mine - explosive. Or alternatively or where the gaps are in their therapist as splitting, sometimes take the therapist into realms lives. This means that they are loving and sometimes hating of dark despair, feelings of often developmentally delayed. them. A healthy individual has incompetency and self-loathing They present as competent the capacity to hold both love and which are implosive. adults but in fact feel inside like hate simultaneously. A healthy It is the therapist’s terrified teenagers and are often individual might love their sister responsibility to ensure that as vulnerable as children. The for being warm and personable resentment does not creep into therapist may be the first person and be able to tolerate, and at the therapeutic space. This may to meet and address these gaps. the same time hate the fact that happen when the therapist goes The therapist therefore needs to she is mostly late or forgets seriously over time with the stay contained, not go beyond things. Whereas for the neurotic client. In a way the therapist is or over-manage boundaries it is an either/or. The psychotic indulging in the grandiosity of and having access to both the struggles with a confusion of “aren’t I so nice and generous, so therapist’s love and hate; able coincident love-hate and flicks as to give this poor wretch more to hold both and tolerate the between the two states. He/she of me”. Or the ego manifests ambivalence. It is so important for might be thrilled and grateful for in the attitude “it’s OK with me the therapist to know, name and the session but arrive the next if you don’t call, show up or express their hate in supervision time fired up with rage.“If the pay, because I’m really so nice or some safe space, whilst analyst is going to have crude and accommodating”. When keeping it from being flung back feelings imputed to him, he is best the work becomes a charitable at the client; in other words, being forewarned…hate that is justified or patronising affair, this is reactive. There is an enormous in the present has to be sorted dangerous territory. When the strain on the therapist who must out” (Winnicott 1947, p. 198). therapist is working late and has hold, contain, without lashing out While unjustified (unconscious) not enough money to adequately at the client or flinging their pent- accusations and imputations maintain himself/herself, have up emotions/thoughts back at the must be tolerated and not reacted a proper holiday or engage in client. Winnicott said that it was to until enough work has been refreshing CPD (Continuing important to hold on and 'survive done with the client. It is obvious Professional Development), this the hour' until things could be that some of the clients’ dark has a deleterious effect on the processed in supervision. For or challenging responses and work and on the mental well- all individuals in the caring behaviours are active symptoms being of the therapist. Where professions (that includes police, and usually unconscious. The there is over-niceness, too much those in prison and probation therapists must dig deep within accommodation of the client, services, and paramedics), I themselves to tap into a reservoir grandiosity in the form of the personally believe in external of compassion for himself/ therapist seeing herself/himself private supervision. What my herself, find patience and then egoically as an expert, points to experience has shown me is the work to understand the client danger. fact that in most institutions, objectively while not taking it Winnicott draws attention to supervision degenerates into personally. However, if there is three categories of clients i) case management. This happens a deep chamber of unprocessed those who have had adequate because it is too threatening to issues within the therapist, the early experiences, ii) clients who admit to a colleague, a senior or client’s behaviour might be like have had traumatic experiences; a line-manager in supervision that

6 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP one is feeling incompetent, stupid in therapy during their training. or furious with a client for fear of he therapist may Therapists appear to have a censure. However, it is those very Tbelieve that they are somewhat omnipotent belief that counter-transferential feelings somehow immunised they are immune to the range and that need to be aired in order to against illness by virtue effects of organic diseases and allow the work to proceed and for of having been through psychical turbulence manifested both the client and therapist not an analysis or having in the general population.” to feel he/she must be on her/his experienced an extended (Jones, 1997, p. 4). best behaviour. This allows the period in therapy during client to express vicious, fearful their training and nasty thoughts and know Dr Coleen Jones that the therapist will be able to contain her thoughts, process her has seen in the therapeutic space emotions and her bad behaviour is tears and irritation. Dr Coleen Jones is a and yet still be empathic, warm psychotherapist and supervisor and caring. Conclusion in practice in Cork. She has Winnicott ends the paper by I have distilled some of worked in the field since 1976 in drawing an analogy between the Winnicott’s wisdom as a way of Johannesburg and in Ireland since experience of the therapist and addressing and alerting ‘caring’ 1990. She worked at University a mother, whose young baby professionals to the dangers of College Cork in Applied Psychology (unknowingly and unconsciously) suicide, burnout or death from ill for 15 years and subsequently treats mother as a slave, who health. At this time of a worldwide was on the board of ICP (Irish refuses her carefully prepared pandemic it is absolutely Council for Psychotherapy) and meals, bites and slaps her, essential that healthcare workers represented Ireland on the board invades her sleep or private life, are careful to protect themselves of the ECP (European Council chews her nipples, spits things mentally and emotionally from the for Psychotherapy) as well as out, expels excretions, drags demands of the work, demands time spent on the accreditation her off in other directions and of their seniors and demands of committee and governing body yet smiles sweetly at strangers. their clients. In some instances, of IAHIP and the supervision According to Winnicott “a they may feel irritation, exhaustion committee of IACP. mother has to be able to tolerate and frustration. They are unlikely hating her baby without doing to lash out at the patient or [email protected] anything [retaliatory] about it.” client, but more likely to take it (1947. p. 202). The parent must out on themselves by working and www.corkpsychotherapyandcounselling eschew sentimentality, not be pushing themselves too hard. All centre.com saccharine, but be willing to healthcare workers need to be hold a line, hold things firmly cognisant of the importance of www.coleenjones.com in place. It is important for the caring for themselves and their parent to realise that as they mental and emotional wellbeing. set boundaries for the child, that “It is a struggle to apprehend References they are providing security and a and articulate the dualistic/ safe base from which the child holistic tension and adequately Jones, Coleen 1997: Psychotherapists and their health; a qualitative analysis of can explore the world; such is express it in words. Splitting awareness as expressed by a random group the nature of good attachment. happens so “naturally that it goes of psychotherapists: University College Cork. As the parent monitors their own unnoticed. These are slippery Jung C.J. 1944: The Psychology of the hate – irritation and exhaustion- it convolutions of thought, difficult Transference: The Practice of Psychotherapy: CW 16. leaves them free of guilt and free to hold and not unlike R.D. Winnicott, Donald, 1947 Through Paediatrics to truly love the child. Surprisingly Laing’s Knots…for example, the to Psychoanalysis: Collected Papers: London. sometimes therapists have the therapist may believe that they Hogarth 1975: Reprinted by Karnac 1992. opportunity of seeing a client at are somehow immunised against Winnicott, Donald (1971) Playing and Reality: a distance in a social context, illness by virtue of having been London: Routledge. who is full of beans and laughing through an analysis or having Winnicott, Donald (1990): Home is where we start from: London: Penguin. excitedly, when all the therapist experienced an extended period

Irish Association for Counselling and Psychotherapy 7 IJCP Volume 20 • Issue 3 • Autumn 2020

Research Article Non-Death Loss and Grief Amy Sweetman and Dr Siobáin O’Donnell

their experiences of non-death related loss and grief and the ensuing complexities. This research examines psychotherapists’ personal experiences of non-death related loss and grief, disenfranchised grief, the impact that this grief may have on their personal and professional life and how psychotherapists manage this vulnerability.

Defining grief Freud (1917/2001) and Bowlby (1969, 1980) enhance understanding of early theories of loss and grief. Bowlby’s (1969) attachment theory posited that individuals are born with an intrinsic need to form emotional attachments with primary caregivers for protection, emotional stability, security, regulating affect and ensuring on-death loss and grief can encompass the same survival. However, when separated Ncommanding, painful and intoxicating feelings from their primary caregiver, an infant that grief experienced through death may arouse. suffers intense feelings of anguish and separation anxiety. Bowlby Psychotherapists are no exception to such fraught (1980) likened grief to a form of agonies of human existence. For many, their loss separation anxiety, heavily influenced and grief may go unacknowledged by others and/ by attachment style. Holmes (2014) suggested that reactions to or by themselves, causing their psychical armour to separation anxiety, such as crying, strengthen tension, pain, anger and despair correlate with the grieving process. Introduction brings many complex responses: Freud (1917/2001) proposed that ark Twain (1966) famously sadness, anger, confusion, disbelief, grieving evokes painful feelings, Mstated that “... Nothing that insomnia, social withdrawal and where one is incapable of embracing grieves us can be called little; by physical sensations (Worden, 2010). a new loved-object. However, the external laws of proportion a Loss and grief are universal, with eventually a grieving individual child’s loss of a doll and a king’s individuals experiencing subjective, realises that they can detach, loss of a crown are events of the unique reactions, which may affect withdraw their libidinal energy from same size” (p. 46). Encountering their personal and professional life their lost loved-object, move forward loss, not exclusively death-related, (Doka, 2016). For psychotherapists, and re-invest in new relationships. brings intense feelings of grief, which their personal experience of loss Freud (1917/2001, p. 243) manifest in diverse forms. Grief may enter their professional observed grief as “reaction to the can occur from the loss of anything environment (Horvath & Symonds, loss of a loved person, or to the which carries significant attachment 1991: Kouriatis & Brown, 2011). loss of some abstraction … such (Kouriatis & Brown, 2011). Grief Therefore, it is important to explore as one’s country, liberty, an ideal

8 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP and so on”. Grief can occur from any and urged professionals to express an individual’s grief in a loss experience, loss of marriage acknowledge divorce as a significant supportive, social environment, such through divorce (Pappas, 1989), loss and grief experience. While as a funeral, usually follow. However, loss of youth (Raphael, 1994), loss going through a divorce, Schlachet with non-death related loss, the of a pet (Cordaro, 2012), loss of (2001) described his intense feelings lack of social validation may result health (Maggio, 2007), loss through of distress and shame, questioning in isolation and loneliness that incarceration, loss of identity (Doka, how could he help clients with may be so difficult for the griever 2016) and so forth. relationship difficulties when he to hold that they disenfranchise Worden (2010) suggests that failed to repair his own. their own grief. Kouriatis and expressions of grief go beyond Waugaman (2013) described his Brown (2013-2014) supported the emotion, often producing irritable personal experience of loss of a concept of disenfranchised grief physical sensations, cognitions and career and an institution which he concluding that during the grieving altered behaviour patterns. Stroebe, loved and his grief on leaving his process, some psychotherapists Hansson, Schut and Stroebe (2008, position as a psychiatrist at Chestnut experienced impediments, especially p. 5) define grief as a “healthy, Lodge. Waugaman’s (2013) loss when family and friends did not natural, emotional reaction containing experience began while still working recognise their loss. Hence, they myriad psychological and physical there due to the death of some may experience their grief as expressions which vary across colleagues and changes in staff and inappropriate or unworthy, disown time and culture”. Several authors ownership. He described leaving as a it and disenfranchise their right to support this multidimensional aspect heartbreaking loss. Secondary losses grieve (Kauffman, 2002). where psychological and physical were loss of family, sense of purpose pain interrelates within the grieving and identity. Impact on professional life experience (De Santis, 2015; Grief carries many complexities that Devilly, 2014; Kouriatis & Brown, Disenfranchised grief may not stay within the confines 2013-2014). Disenfranchised grief occurs when of an individual’s personal life, but the loss is outside societal grieving seep into their professional life. For a Secondary losses rules, not openly recognised by psychotherapist, this may impact on Secondary losses stem from others, publicly shared or socially the therapeutic relationship. a primary loss (Doka, 2016). For validated (Doka, 2016). Despite an Reiter (1995) advocated that the example, the primary loss of a individual’s intense grief reactions, meaning and emotion that emerges job may create secondary losses society, family and friends may in therapy arises from the co-created of income, purpose and identity. not fully recognise or acknowledge relationship between therapist and (Murray, 2016). Boyden (2005) their right to grieve, therefore client, where both influence each agreed that previous/multiple losses disenfranchised grief may restrict this other. Wallin (2007) asserted that impacted the initial loss, saying right, intensify emotional reactions the therapeutic relationship is an that one may re-experience previous and exacerbate the grief (Doka, intersubjective space where both losses activated by a primary loss 2008). Doka (2008) proposed that therapist and client consciously and/or experience multiple losses every culture has grieving traditions, and unconsciously influence each concurrently. policies, norms or rules of behaviour: other. Kouriatis and Brown (2013- Pappas (1989) explored the who can grieve, for whom or what 2014) stated that therapists’ loss possible impact of divorce on and how to respond to another’s experience impacted the therapeutic psychotherapists’ personal and grief. He postulated typologies of relationship, with both positive and professional life, causing multiple disenfranchised grief related to non- negative outcomes. A number of losses beyond the loss of spouse death related loss, divorce, mental studies found psychotherapists’ and marriage including standard of and physical illness, addiction, increased empathy due to life, friends and family leading to incarceration, unemployment, their grieving, strengthened the feelings of isolation and personal relationship break-down and so on, therapeutic alliance. However, failure, that exacerbate complex grief suggesting that societal grieving Kouriatis and Brown (2013-2014) reactions. Pappas (1989) explained laws do not apply to non-death loss. proposed that psychotherapists’ that intense feelings of guilt and Individuals lacked social support experience of loss may have a shame may prompt a psychotherapist when their loss was outside societal negative effect due to their emotional to question their ability to support grieving rituals (Thornton, Gilleylen& vulnerability. Hayes et al. (2007) their clients. She explored the Robertson, 1991). Pappas (1989) suggested that the more intense intense grief reactions experienced stated that with death, rituals to a therapist’s grief experience, the

Irish Association for Counselling and Psychotherapy 9 IJCP Volume 20 • Issue 3 • Autumn 2020 less empathic a client experienced personal therapy, professional the therapist to be. However, uring the grieving programmes and colleague the more a therapist had worked Dprocess, some assistance helped manage their through their grief, the more psychotherapists vulnerabilities. empathic they became. De Santis experienced impediments, (2015) suggested that a vulnerable especially when family The present study therapist may project their thoughts and friends did not The present study collected data to and feelings onto the client, risking explore psychotherapists’ personal therapeutic disconnection. De Santis recognise their loss experiences of non-death related (2015) found the more vulnerable a (Brown (2013-2014). loss and grief, disenfranchised grief therapist felt, the more they relied and the impact that grief may have on the therapeutic technique of on the therapeutic encounter. Semi- bracketing, to separate personal and slowly eroded helping her recognise structured interviews were conducted professional. Adams (2014, p. 2) and accept her vulnerability. with five fully accredited, humanistic/ stated that she relied on bracketing Kooperman (2013) postulated that integrative psychotherapists who had to protect her vulnerable self and her self-awareness and robust self- personal experience of non-death clients. However, she changed her care practices are key to managing related loss and grief. Data were view on bracketing, stating that it personal loss and vulnerability. analysed through thematic analysis. was “simply an illusion”. De Santis Mahoney (1997) researched Several themes emerged which are (2015) concluded that bracketing psychotherapists’ self-care patterns. now discussed in light of current hindered therapists’ awareness Holidays, reading, hobbies and literature. and when bracketing was not used exercise were most commonly therapists could easily access reported. Volunteer work, meditation The grieving experience their emotions leading to a deeper and peer supervision were frequently The multidimensional aspect of therapeutic connection, stronger reported, and least reported were grief manifests through emotions, attunement and a greater sense of personal therapy, church, chiropractic cognitions, behaviours and physical empathy. and keeping a personal diary. symptoms (Worden, 2010). This Although personal therapy was present study supported this Managing vulnerability and self-care one of the least common forms of multidimensional aspect. Several Following a significant loss, a self-care reported, the majority of participants reported that their grief psychotherapist may manage their respondents who did report personal not only had a psychological effect but vulnerability using primitive defences, therapy were female, implying a also manifested physically, cognitively whereby intense feelings of grief are gender difference in personal therapy and behaviourally. They reported denied (Bram, 1995). Therefore, as a form of self-care. Devilly (2014) many painful emotions, behaviour the management of vulnerabilities agreed, reporting that only half of disruptions and physical pain. and self-care is imperative. Elliott their participants, all female, were in Annie recalled the breakdown of an (1996), while living with Parkinson’s personal therapy and only females important, intimate relationship. She Disease, experienced the deep reported engagement with self-care stated that her self-worth and “sense sorrow of isolation and vulnerability. by cooking healthy meals, exercising of validation” were attached to the However, she explained that there is and relaxation. Both male and female relationship. When the relationship an intrinsic strength in recognising participants utilised supervision as ended, Annie recalled feeling and accepting personal vulnerability. a self-care practice. Kouriatis and sick and tearful and questioning Counselman and Alonso (1993) Brown (2013-2014) proposed that “everything”. Eugene, after a highlighted that a therapist’s ability while grieving, self-reflection and relationship breakdown, reported to empathise might be threatened if supervision are essential. Broadbent feelings of confusion and disbelief. they deny their vulnerability, leading (2013) found that all participants Peter recalled intense, distressing to catastrophic repercussions. committed to a continuous process feelings after unexpectedly losing his They stressed the importance of of self-questioning and self-reflection, job, stating that he felt “angry, sad, authenticity in an attempt to lower entered personal therapy when confused” and “distanced myself the blocking defences of denial necessary and reported supervision from family”. Gillian reported a deep and provide clients with an open, as a safe space to explore their sadness that her children were not genuine space. Maggio (2007) vulnerabilities. Barnett, Baker, Elman living nearby and yearned for her recalled that as her chronic lupus and Schoener (2007) postulated that grandchildren. June recalled feelings illness worsened, her use of denial using supervision, group supervision, of shock, anxiety and uncertainty

10 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP when diagnosed with an aggressive operating according to society’s tumour in her ear, describing rief from secondary grieving expectations (Kauffman, sadness and “massive fear” for her G loss could be as 2002; Kouriatis & Brown, future. intense as the initial loss 2013-2014). Participants reported Physically, June reported insomnia, and further complicate disacknowledgement of their own loss of appetite, vertigo and the grieving process grief. Peter stated that he found it questioned what losing her balance difficult to communicate his feelings meant for her. Annie reported (Murray 2016) and fully acknowledge his intense feelings of loneliness, sadness and feelings as grief as he “didn’t want intense anxiety and reflected on the anyone feeling sorry” for him. Peter physical sensations she experienced hindrances to their grieving, where reported that he tried to stop the during her grief - hollowness in her their grief went unrecognised grief and avoid the negative feelings. stomach that would shoot up into and unacknowledged by others June disallowed herself freedom to her chest.This concurs with the or themselves. Eugene recalled grieve, as she did not want “anyone multidimensional aspect of grief and the absence of support when making allowances” for her. She Kouriatis and Brown’s (2013-2014) his relationship ended and the recalled how she chose not to notion that the psychological and challenges to expressing his grief. acknowledge or express her grief as physical pain of grief may be closely He stated “People … didn’t quite “it was a bit risky … I wouldn’t have interrelated. understand ...that made it harder”. allowed myself ... I didn’t want pity ... Similarly, Gillian reported lack of I put up a wall”. Secondary loss understanding and acknowledgement The present research findings Following a loss, an individual of her grief during her illness. Annie reflect Kauffman (2002) who may experience secondary losses, described initially having support proposed that self-disenfranchised requiring them to also identify, name from her sisters, however, later their grief was a failure of an individual’s and grieve those losses (Boyden, support dwindled and her grief went self-empathy leading to disapproving 2005; Doka, 2016). Several unrecognised. and disowning part of themselves. participants in this present study These hindrances correlate reported secondary losses as a with Doka’s (2008) notion of Challenges and advancements in consequence of their primary loss disenfranchised grief. Annie reported the room and described the influence of those that she was repeatedly advised to Some of the present research secondary losses on their grieving “get over it”, which caused her to findings agreed with Kouriatis and experience. stay silent. Annie stated that she felt Brown’s (2013-2014) notion that a Following the loss of her like she was “going crazy” and “that psychotherapist’s loss experience relationship, Annie recalled losing her there was something wrong” with may negatively impact their security and consequently her feeling her. Eugene recalled the difficulty therapeutic work. The participants of safety. For Annie secondary losses he experienced in his grief due reported that their experience of grief were “friend, partner, confidant ... to the lack of understanding and enhanced their ability to be with their financial security, emotional security support while Gillian experienced clients, but they acknowledged the ... I felt so unsafe ... it wasn’t just a disenfranchisement of her loss struggles encountered. With regard to one loss which is why it was so of her adult children living abroad, bracketing, Eugene reflected on his traumatic, it was many losses”. which went unnoticed by them. This ability to separate his personal and Peter illustrated how the primary job concurred with research which found professional life. He reported that loss initiated further losses: income, that non-death related loss and during the time of his grief, although purpose and role in life, stating “I grief were more likely to lack social there were times clients’ issues went from a contributing member support, acknowledgement and would echo what he was feeling, the of the family to a non-contributing understanding (Kouriatis & Brown, work still distracted him. member”. Murray (2016) postulated 2013-2014; Thornton et al., 1991). Peter experienced that intensity that grief from secondary loss could of the co-created therapeutic be as intense as the initial loss Self-disenfranchised grief relationship and the shared influence and further complicate the grieving Self-disenfranchised grief with his clients (Reiter, 1995). He process. emerges with the lack of self- recalled that sometimes he found acknowledgement of loss and himself shifting the conversation to Hindrance in a therapist’s grief grief and a grieving individual something less painful for him, to All participants experienced who disenfranchises their grief is stop the client’s feelings “provoking

Irish Association for Counselling and Psychotherapy 11 IJCP Volume 20 • Issue 3 • Autumn 2020 emotions in me that I didn’t want to 1993). Many participants in this be listened to and feel safe to share be provoked”. Peter reported that present study reported great difficulty their vulnerabilities (Broadbent, after losing his job he worked in managing their grief and reflected on 2013; Devilly, 2014; Mahoney, a centre offering free counselling, protecting their vulnerability through 1997). Several participants from he was triggered by a financially using defences (Bram, 1995). June this study reported supervision as successful client stating, “me who described how she put up walls and one of their main supports. There had no job was giving myself to concentrated on other issues. She were mixed feelings about personal somebody ... who had a very well reflected on reading stories of cancer therapy. This study found that there paying job ... made me really angry” patients, chosing only to read the was no gender difference regarding adding “we can’t just leave stuff strong, positive stories, adding that personal therapy as a supportive self- outside the door”. June reported her she refused to allow herself to be care practice. Eugene recalled that difficulties after her surgery where vulnerable. Annie coped by keeping he attended personal therapy to work she had to “brace” herself as the her pain and grief at a distance through his grief. However, Annie struggle to hear caused discomfort. stating “The denial ... I was putting reported that personal therapy was She reflected that she was “still it off, cause it was too hard”. She not a part of her self-care stating, “I fairly shaky”, that the first week was kept her vulnerability at bay to focus burnt myself out in personal therapy extremely difficult. She acknowledged on what she “was supposed to be talking about the relationship ... I the possibility that this may have doing”. Similarly, Peter reported couldn’t wait to get away from it”. negatively impacted her work. This relying on denial to convince himself June stated that her self-care concurred with De Santis’s (2015) that “I’ll be ok”. Peter recalled practices were mindfulness, peer conclusion that a vulnerable therapist being exposed to the potential groups and connecting with friends. may be in jeopardy of therapeutic risks a vulnerable therapist faces Less frequently reported in this study disconnection and may confront in maintaining empathy towards his was connecting with friends and challenging experiences with a client. clients. However, he reported that he peer groups, however Barrnett et al. Many grieving psychotherapists was able to maintain empathy and (2007) argued that peer groups were experienced positive impacts in their lower his defence of denial through very supportive. The management therapeutic work. All five participants self-reflection and self-awareness. of vulnerability appeared to be reported positive impacts: increased Kooperman (2013) validated self- challenging for some therapists who empathy, understanding and self- reflection and self-awareness as relied on their defences to cope with awareness. Eugene recalled feeling powerful mechanisms in managing pain. However, the importance of “more empathic”. Gillian reflected vulnerability. Gillian reported that self-care practices emerged for all on the great empathy she held for she managed her vulnerability by therapists. a particular client - a young mother acknowledging it: “knowing my limits with cancer, saying that although it … finding supports”. Conclusion was “very close to the bone” she While all the participants reported This research explored the was able to separate work from difficulties in managing their meaning of loss and highlighted personal. Annie reported that while vulnerability, often relying on their the complex, idiosyncratic nature there were difficult times, she began defences as psychical armour, they of non-death loss and grief. All to experience a deeper connection commented on the importance participants reported experiencing to and more empathy for her clients, of self-care. The most frequently numerous difficult emotions stating that she felt “alive again” and reported self-care practice was during grieving which manifested that she and her clients were learning exercise. Gillian reflected on long psychologically, cognitively, physically from each other as if they were on a walks. Peter stated that his self- and behaviourally, indicating the journey together, similar to Kouriatis care was being outdoors and going multidimensional aspects of grief. and Brown’s (2013-2014, p.101) for walks by himself to help clear They reported experiencing a idea of increased ability of “walking his mind. Eugene reported dance multitude of secondary losses which alongside” clients. practice and Annie stated “Running further exacerbated their grieving gave me a purpose ... sense of experience. This study highlighted Protecting vulnerability and self-care freedom and empowerment ... sense that loss is a unique experience practices of identity’ where she had formerly that can derive from any significant A vulnerable therapist, using the said she had lost her sense of self. loss. Therefore, this research has defence of denial, may impact their Therapists frequently reported broadened the scope and meaning ability to operate in their clients’ supervision as part of their self-care, of loss through the exploration best interest (Counselman & Alonso, as great support, where they could of non-death related loss and

12 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP grief. The acknowledgement of a REFERENCES psychotherapists’ humanity has Adams, M. (2014). The myth of the untroubled Horvath, A. O., & Symonds, B. D. (1991). Relation therapist: Private life, professional practice London: between working alliance and outcome in psycho- shone throughout this research, with Routledge. therapy: A meta-analysis. Journal of Counselling a boisterous, echoing message that Barnett, J. E., Baker, E. K., Elman, N. S., &Schoen- Psychology, 38(2), 139-149. humanness comes above all else. er, G. R. (2007). In pursuit of wellness: The self- Kauffman, J. (2002). The psychology of disenfran- care imperative. Professional Psychology: Research chised grief: Liberation, shame and self- disenfran- and Practice, 38(6), 603-612. chisement. In K. Doka (Eds.), Disenfranchised grief: Bowlby, J. (1969). Attachment and Loss. 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Professional Psy- for a safe working environment, a significant personal bereavement and its impact chology: Research and Practice, 28(1), 14-16. upon their therapeutic practice: An exploratory where an individual can explore Martin, P. (2011). Celebrating the wounded healer. study. Counselling and Psychotherapy Research, Counselling Psychology Review,26(1), 10-19. their inner world creating space for 13(4), 263-271. Retrieved from http://search.ebscohost.com/login. healing and growth. Amy works with Cordaro, M. (2012). Pet loss and disenfranchised aspx?direct=true:AuthType=ip,shib,cookie,url&db grief: Implications for mental health counselling a9h&AN=58035872&site=eds-live an array of issues, including, but practice. Journal of Mental Health Counselling, Murray, J. (2016). Understanding Loss: A guide 34(4), 283-294. not confined to non-death loss and for caring for those facing adversity. London: Counselman, E. F., & Alonso, A. (1993). 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Stroebe (Eds.), Handbook of BA in TCD, Dr Siobáin O’Donnell Doka, K. J. (2016). Grief is a journey: Finding your bereavement and practice: Advances in theory and graduated with honours from the path through loss. Maine: Thorndike. intervention (pp. 3-26). Washingtion, DC: American MA in Addiction Studies programme Elliott, C. M. (1996). Through a glass darkly: Psychological Association. Chronic illness in the therapist. Clinical Social Work Thornton, G., Gilleylen, C., & Robertson, D. U. in DBS School of Arts in 2000 and Journal, 24(1), 21-34. (1991). Disenfranchised grief and college students’ successfully completed her PhD in Freud, S. (1917/2001). Mourning and Melancholia. rating of loss situations. Paper presented at the In J. Strachey (Ed. And Trans.), The standard edition annual meeting of the Association for Death Educa- TCD in 2015. Siobáin has worked of the complete psychological works of Sigmund tion and Counselling, Duluth. as a Research Officer on social Freud (Vol. 14). London: Hogarth Press. (Original Twain, M. (1966). Mark Twain’s ‘Which Was the work published 1917). Dream?’. In J. S. Tuckey (Ed.), ‘Which Was the research projects, for example, Gelso, C. J., & Hayes, J. A. (2007). Countertrans- Dream?’ and Other Symbolic Writings of the Later Dept of Psychology, Royal College ference and the therapist’s inner experience: Perils Years (pp. 33-75). Berkeley: University of California and possibilities. Mahwah, N.J: Lawrence Erlbaum Press. of Surgeons on the SAVI Project and Associates. Wallin, D. J. (2007). Attachment in Psychotherapy. with the Granada Institute on “An Givelber, F., & Simon, B. (1981). A death in the New York: Guilford Press. life of a therapist and its impact on the therapy. Waugaman, R. M. (2013). The Loss of an Insti- evaluation of treatment efficacy with Psychiatry, 44(2), 141-149. tution: Mourning Chestnut Lodge. In A. Adelman types of men who sexually abuse Hayes, J. A., Yeh, Y.-J., & Eisenberg, A. (2007). & K. Malawista (Eds.), The Therapist in Mourning: children”, Siobáin has been lecturing Good grief and not-so-good grief: Countertransfer- From the Faraway Nearby (pp. 158-177). New York: ence in bereavement therapy. Journal of Clinical Columbia University Press. in DBS for the past 19 years in the Psychology, 63(4), 345-355. Worden, J. W. (2010). Grief counselling and grief Departments of Psychotherapy and Holmes, J. (2014). John Bowlby and Attachment therapy: A handbook for the mental health practition- Theory. (2nd ed.). London: Routledge. er. London: Routledge. Social Sciences.

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Practitioner Perspective Perinatal Grief – A Profound and Complex Process By Cathy Quinn

This article provides an overview of the multiple facets of perinatal grief and the grieving process. It explores the key concepts of continuing bonds and the complexity of disenfranchised grief. It also reflects briefly on the significance of creating a safe empathetic space.

Perinatal death in perspective In the past, the predominant culture of maternity hospitals and society in general tended to minimise or even ignore the existence of perinatal grief. Today compassionate approaches to care are slowly but positively transforming the landscape and culture of how we care for this umerous studies demonstrate that grief following vulnerable group of parents, for Na baby’s death is frequently minimised and may example the introduction of the go unacknowledged by society. These findings challenge National Standards for Bereavement Care following Pregnancy Loss and us not only to grasp the significant impact of the Perinatal Death (Health Service sociocultural dynamics woven into perinatal grief but Executive (HSE), 2016). also to create an empathetic therapeutic relationship, In 2016, a total of 227 babies were stillborn and 124 babies wherein bereaved parents are truly understood died within the first week of life in Ireland (Healthcare Pricing “When you are understood, you are born alive but dies within the first Office & HSE, 2018). Miscarriage at home. Understanding nourishes week of life. The profound grief occurs in approximately one- belonging. When you really feel experienced by parents following fifth of pregnancies equating to understood, you feel free to miscarriage or the death of their approximately 14,000 miscarriages release your self into the trust and baby is considered a complex per year in Ireland (Poulose, shelter of the other person’s soul” emotional response (Fenstermacher Richardson, Ewings & Fox, 2006). (O’Donohue, 1997, p. 13-14) & Hupcey, 2013). However, the Concealed in these statistics are majority of bereaved parents will an enormous number of bereaved Introduction experience a normal grief reaction parents and their families who erinatal grief embraces the grief with the support of family and undeniably will require empathetic Pexperienced by parents following friends (McSpedden, Mullan, care and support. miscarriage, following a diagnosis Sharpe, Breen, & Lobb, 2017). during pregnancy of a baby with Additional support may be sought Multiple facets of perinatal grief a life-limiting condition, when a from advocacy groups, while some To empathise fully with bereaved baby is stillborn or when a baby is parents may attend counselling. parents’ experience of perinatal

14 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP grief, the counsellor needs to impact of their baby’s death recognise the multiple facets of nforming parents of the on their relationship; they may perinatal death that are woven Iindividuality of grief is struggle to find the emotional into the tapestry of grief and helpful; although they are resilience to help each other undoubtedly impact the parents’ both grieving as parents of while they are individually coping grief response. the same baby, each parent with their own grief. Studies have Perinatal grief is unique given may grieve differently and shown that parents who share that most mourning is retrospective and communicate their grief whereas perinatal grief is are rarely synchronised in report less severe grief reactions prospective mourning i.e. parents their grief and greater partner satisfaction have to relinquish hopes, wishes (Cacciatore et al. 2008; Buchi and dreams about a future together et al. 2009; Avelin, Radestad, with their anticipated baby (Leon, and anxiety symptoms following S¨aflund, Wredling, & Erlandsson, 1990). They grieve for what might perinatal death (Blackmore et al. 2013). In contrast, other studies have been, a future with their baby 2011; Cheung, Hoi-yan, & Hung-yu, have identified perinatal death suddenly vanishes when unfulfilled 2013; Christiansen, Elklit, & Olff, as a risk factor for relationship dreams and expectations are 2013; McSpedden et al. 2017). break-down (Gold, Sen, & Hayward, crushed. Seeing live healthy babies of 2010; Shreffler, Hill, & Cacciatore, A baby’s death goes against family and friends may be difficult 2012). Informing parents of the the natural sequence of life for parents; particularly in the early individuality of grief is helpful; events, is frequently unexpected stages of grief; they may struggle although they are both grieving as and the cause of death may be to cope with painful feelings or parents of the same baby, each unexplained. Furthermore, there are avoid situations, which can lead to parent may grieve differently and no formal funeral or burial rituals isolation. are rarely synchronised in their for babies usually associated with Parents may also be fearful and grief. Encouraging parents to share other deaths which may limit social doubt their ability to have a live their feelings may help them to acknowledgement and support. healthy baby in the future. Well- understand each other’s unique Consistent feelings of guilt, meaning family and friends and reactions and ultimately avert or shame and failure, combined society in general may sometimes lessen tensions that may develop with self-blame and low self- assume that a subsequent in their relationship. Open, honest, esteem, may dominate the pregnancy will instantly heal communication with their surviving parents’ landscape of grief (Barr the parents’ grief, resulting in children is also encouraged. & Cacciatore, 2007; Wonch Hill, diminished opportunities for Grieving the death of a baby of a Cacciatore, Shreffler, & Pritchard, parents to share their true feelings multiple birth is a complex process 2017). A study conducted by (Markin, 2016; Meaney et al. 2017) for families (Richards, Graham, Meaney, Everard, Gallagher and In the midst of the parents’ Embleton, Campbell, & Rankin, O’Donoghue, (2017) revealed that grief, the focus of support may 2015). Parents often experience bereaved parents experienced a be directed solely towards the a rollercoaster of conflicting sense of failure which battered mother’s needs which may emotions: grief for the baby who their self-esteem and mothers in lead to the father’s grief going has died, as well as hopes and particular felt guilty and blamed unacknowledged by society. Fathers fears for their vulnerable baby/ themselves for their baby’s death. may feel they have to be stoic babies who survive. Parents may These complex, intrusive feelings and society may dictate this. In keep their emotions on hold while of shame, failure and guilt may a study by Meaney et al. (2017) caring for the surviving baby and a impede the grieving process and fathers reported that they had to be strong grief reaction may emerge damage a vulnerable self-esteem, strong emotionally, at times putting weeks, months or even years later thereby increasing the risk of their own grief on hold in order to (Richards et al. 2015) complicated grief (Markin, 2017). support their partner. Validation Early and late miscarriage may be Counsellors should be alert to and acknowledgement of the experienced as a highly traumatic pathological symptoms of grief father’s grief experiences and his loss for many women, yet it may be that may arise as several studies fatherhood is essential (Cacciatore, minimised and go unacknowledged have reported elevated levels of DeFrain, Jones, & Jones, 2008). by society (Gerber-Epstein, complicated grief, post-traumatic Another challenge that bereaved Leichtentritt, & Benyamini, 2009; stress disorder, depression parents have to negotiate is the Murphy & Merrell, 2009; Sejourne,

Irish Association for Counselling and Psychotherapy 15 IJCP Volume 20 • Issue 3 • Autumn 2020

Callahan, & Chabrol, 2010). Lack grief reaction and an obstacle to of tangible mementos, especially he deceased baby successful grief resolution (Klass, in early pregnancy loss, limited Tis both present and Silverman, & Nickman, 1996). The empathy and support from family absent; there is a physical general consensus among grief and friends with few opportunities letting go of the deceased theorists echoed a belief that in to engage in culturally recognised baby but at the same order to resolve their grief, it was mourning rituals, which may lead to time keeping hold of the necessary for the bereaved to sever social isolation and disenfranchised bonds by detaching themselves grief (Kersting, & Wagner, 2012; connection or the bond emotionally from the deceased Bellhouse, Temple-Smith, & Bilardi, person. 2018). with the changes that occur as a It was Klass (1988) who first Parents who decide to terminate consequence of the baby’s death. reported that bereaved parents their pregnancy when their baby They are faced with the challenges maintained a bond with their is diagnosed with a life-limiting of readjusting to their changed deceased baby. However, he condition may experience higher world without their baby; learning did caution that it may not be levels of self-blame, guilt, and to live with the death in the face of representative of all bereaved social isolation (Maguire, 2015). bereavement and rebuilding their parents (Klass, 2006). He They may seek counselling, feeling lives by creating a new normal. supported the theory that a baby’s unsupported or stigmatised and Oscillation between the two types death ended a life but the profound will require an empathetic, non- of coping is necessary to grieve connection lived on. The deceased judgemental, safe space to process effectively; parents need to be able baby is both present and absent; their feelings (Markin, 2017). to engage with their grief and also there is a physical letting go of the detach from their grief (Stroebe deceased baby but at the same The grieving process & Schut, 2010). Healthy grieving time keeping hold of the connection Stroebe and Schut (1999) involves being able to do both and or the bond. The true essence developed the Dual Process to move from one to the other. of continuing bonds is captured Model (DPM) of coping which is Difficulties occur in the grieving by baby Laura’s mother, “In this an extension of the earlier linear process when there is a persistent unsettled ‘after’ life with its melee models of grief. This model is lack of oscillation between of feelings and words, Laura is a extremely helpful when working experiencing and detaching from part of our journey onwards. She is with parents as it considers the grief. Under such circumstances in the way we love each other now. uniqueness of each parent’s the parents are either totally She is in how we live. We do not complex and highly individualised overwhelmed by the experience or live without Laura. We live with her experience of grief. The model also they systematically repress it. In ever-present absence. And that is recognises the effect of cultural both situations there is a persistent not to say our lives are lived with and religious beliefs on the grieving sense of ‘stuckness’, a distinct the constant question: What if? process. feature of complicated grief. What if? What if? It is to say she The DPM of coping with significant is present in how we notice each loss is based on the principle that Continuing bonds other, how we hear each other. when people are grieving effectively, “We let go the loved one, not the Laura is there in our sadness, but there is a natural oscillation love” (Fallon, 2014) in our happiness too” (O’Connor between two types of coping. It is essential that counsellors Foott, 2015, p. 11). Loss-orientation coping relates to recognise that for many parents, Many bereaved parents integrate engaging with grief work, whereas continuing bonds with their the memory of their baby by restoration-orientation coping deceased baby, in a manner that continuing bonds in various ways: relates to adjusting to the changes maintains a healthy adjustment that occur as a consequence to grief, is deeply woven into • Talking about their deceased of the death. In loss-oriented their grieving process. Creating baby and sharing memories coping, parents are confronting mementos and storing memories with family, friends, healthcare the painful reality of their baby’s become a significant part of the professionals, within support death e.g. painful expression of parents’ life moving forward without groups or with their counsellor, a range of emotions and talking their baby. Historically, continuing enables them to continue their about their baby. In restoration- bonds with the deceased person bond with their deceased baby in oriented coping parents are coping was considered a maladaptive a way that is meaningful to them

16 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

• Sharing linking objects e.g. recounted parents’ experiences of mementos, photographs. A or many women, disenfranchised grief which included bereaved father describes the F advanced scanning insensitive language used by significance of his daughter technology influences the professionals, insensitive comments, Matilda’s amulets “the things mother’s attachment to avoidance and perceived lack of she touched, that were a part of partner and social support. her, are sacred. We hoard them, her baby in the womb, Doka (1989) referred to society’s treat them with the reverence of long before the baby is grieving rules that attempt to dictate archivists, and like curators worry born how people should grieve. Society uncontrollably that they will be lost, may decide what level of grief should broken, or consumed by a fire” (Atluru, Appleton, Kupesic, Plavsic, be attributed to a specific death/ (Weaver-Hightower, 2011, p. 475) Kurjak, & Chervenak, 2012) loss e.g. the grief of early miscarriage may be viewed as a lesser grief, • Choosing a central location in the strengthening their support system consequently minimising the loss home to display photos of their which may ultimately reduce their and negating the grief reaction. For baby with other family photos risk of social isolation and/or many women, advanced scanning • Preserving memories e.g. writing disenfranchised grief. technology influences the mother’s their baby’s story, a book, attachment to her baby in the womb, personal blog, poems, songs, art Disenfranchised grief long before the baby is born (Atluru, and craft work, planting a tree/ To work empathetically and Appleton, Kupesic, Plavsic, Kurjak, flowers, fundraising and donating effectively with bereaved parents & Chervenak, 2012). However, to support groups or maternity and families, counsellors need to society may not always recognise hospitals be aware of and understand the the significance of this relationship, dynamics of disenfranchised grief. especially if she miscarries or if • Continuing rituals e.g. visiting Social support has consistently her baby is stillborn, resulting in the baby’s grave or special been shown to provide a buffering insensitive comments implying she place. Creating rituals that evoke effect on the impact of perinatal never knew her baby. According to memories at significant times/ death, yet this impact can often Lang et al. (2011) parents reported anniversaries e.g. on baby’s due be minimised, especially following that overall, extended family and date, baby’s birthday, date of miscarriage, and go unacknowledged society failed to understand and death or at Christmas time by society and sometimes by family acknowledge the significance of and friends (Gerber-Epstein et al. their baby’s death and its parity with • Attending the hospital or local 2009; Bellhouse et al. 2018). As a other deaths. Consequently, in the remembrance services consequence, bereaved parents are absence of family and social support, denied the opportunity to publicly parents may seek out support • Creating memorials to honour mourn their baby and may not have from advocacy groups e.g. A Little their baby e.g. park bench or the usual support that is available Lifetime Foundation, Féileacáin or memorial garden following the death of an adult which the Miscarriage Association. Other in turn may lead to social isolation parents may attend counselling, • Integrating the people who and disenfranchised grief. Doka where the presence of an empathic companioned them on their grief (1989) defines disenfranchised therapeutic relationship will enable journey into their lives and into grief as a loss that is not openly them to explore the impact of their narrative going forward acknowledged or visibly supported disenfranchised grief and re-establish By continuing bonds the deceased by society. Grief following perinatal their right to grieve. baby is acknowledged, honoured death is particularly susceptible to and rightfully occupies a unique being disenfranchised, making this Creating a safe empathetic space place in the family and in society an additional burden for parents who Entering the bereaved parents’ world (Côté-Arsenault & Denney-Koelsch, are denied a socially recognised challenges counsellors’ attitudes 2016). Bereaved parents delicately right to grieve and this may intensify and beliefs in relation to perinatal weave their deceased baby’s or impede their healing process death. Markin, and Zilcha-Mano memory into the fabric of their (Lang, Fleiszer, Duhamel, Sword, (2018) suggest that as counsellors altered daily lives, their families Gilbert, & Corsini-Munt, 2011; “we too are products of our culture lives, extended family, circle of Mulvihill & Walsh, 2013). A study and absorb the cultural denial friends and their community, thereby by Mulvihill and Walsh (2013) around perinatal grief” (p.24).

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Consequently, self-awareness is As some parents experience Conclusion vital in exploring how counsellors’ disenfranchised grief, a safe, Bearing witness to bereaved personal/family stories, culture, trusting and empathic space is families pain and journeying with beliefs and experiences may impact crucial in giving them a voice to them following their baby’s death on the care provided for bereaved express their hidden grief. It enables is both challenging and rewarding. parents. the parents to mourn their baby; to An awareness of our assumptions, Cacciatore (2017) explored what tell their story and to express and attitudes and beliefs in relation to parents found helpful/unhelpful experience their emotional pain. perinatal death is crucial for effective in relation to counselling they In this safe space, the counsellor empathetic therapy. Counsellors received following their baby’s is present in the here and now need to be cognisant of the death. Counsellors were deemed and comfortable bearing witness multiple facets of perinatal death most helpful by participants to the parents’ pain and suffering, and recognise that each parent’s when they were empathetic, non- is willing to sit with it, by listening approach to grief is unique to them. judgmental, listened attentively, intently to understand their story, An empathetic non-judgemental acknowledged parents’ feelings by acknowledging, validating and and created a space for parents approach to providing support will normalising their feelings. Wolfelt facilitate the creation of a safe space to tell their story and process their (2005) reminds us that being fully emotions. Unhelpful counsellors were where parents are afforded the time present to another person’s pain is to express, experience and process reported as lacking empathy, being about being still; being comfortable their grief; where they are truly heard judgemental, minimising parents’ with chaos and profound heartache and their feelings acknowledged and feelings with insensitive comments and avoiding the temptation to validated. By working in partnership and attempting to find/force meaning impose order and logic. in the baby’s death. Cacciatore with parents, we enable them to According to Markin (2017) (2017) proposed that counsellors grieve and empower them to rebuild “emotional experiencing and should integrate mindfulness-based a meaningful life without their expression of feelings related to approaches into their practice baby. grief and loss are key to successful e.g. compassion, non-judgement treatment” (p. 370). Within a safe and acceptance, to facilitate the therapeutic alliance, intense feelings creation of a safe empathetic space. of guilt, anger, shame or failure may Counsellors need to recognise that Cathy Quinn emerge during therapy. Self-blame each circumstance of perinatal death and a crushed self-esteem may also is unique and the intensity and/or Cathy Quinn is a registered be evident, all of which can impede duration of the parents’ grief reaction nurse, midwife and an accredited the grieving process. is not founded on the number of counsellor with an MSc (Hons) in weeks of pregnancy or how long the Counsellors need to be acutely aware of these feelings and have Counselling. She has over 20 years’ baby lived. Irrespective of when or experience in working with bereaved how the baby died, our challenge is the competence to recognise and hold the intensity of the parents’ parents and their families. Cathy to listen with our heart as opposed developed an innovative Midwifery- to analysing with our head, to avoid emotional experience, without led counselling service in 1991 for assumptions and to connect with judgement. Counsellors should also bereaved parents - the first to be parents at where they are on their be mindful that unresolved losses, established in an Irish maternity grief journey, not where we want which may or may not be pregnancy hospital. She is a contributing them to be. related, may also be reawakened by A genuine therapeutic relationship the baby’s death and will also need lecturer in delivering the MSc and empathetic presence are core to be mourned. Perinatal Mental Health Programme healing qualities which have the Parents may find that keeping a at the University of Limerick; leading ability to temper parents’ grief and journal of their feelings or setting the Perinatal Bereavement and Loss soothe their brokenness. Empathetic up a blog may also help to temper Module and lectures at the Graduate engagement respects the parents and their grief. Other parents may find it Entry Medical School. She also their deceased baby, their feelings, difficult to articulate their profound facilitates perinatal bereavement their stories and experiences and their grief and they may grieve and care workshops for healthcare unique reaction to their baby’s death remember their baby by creative professionals. which ultimately facilitates healing and expression e.g. through music, the process of mourning. song, artwork or poetry. [email protected]

18 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

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Atluru, A., Appleton, K.R., Plavsic, S.K., Kurjak, Oldcastle: Gallery Press. predictors of complicated grief symptoms A., & Chervenak, F.A. (2012). Maternal- Fenstermacher, K., & Hupcey, JE. (2013). in perinatally bereaved mothers from a Fetal Bonding: Ultrasound Imaging’s Role in Perinatal Bereavement: A Principle-based bereavement support organization. Death enhancing This Important Relationship. Donald Concept Analysis. Journal of Advanced Nursing, Studies, 41(2), 112-117. School Journal of Ultrasound in Obstetrics and 69(11), 2389–2400. Meaney, S., Everard, C.M., Gallagher, S., & Gynecology, 6(4), 408-411. Gerber-Epstein, P., Leichtentritt, R. D., & O’Donoghue, K. (2017). Parents’ concerns Avelin, P., Radestad, I. S¨aflund., K. Wredling, Benyamini, Y. (2009). The experience of about future pregnancy after stillbirth: a R. & Erlandsson, K. (2013). Parental grief and miscarriage in first pregnancy: the women’s qualitative study. 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Poulose, T., Richardson, R., Ewings, P., & Fox, R. (2006). Probability of early pregnancy loss J., Glaser, A., Fauchere, J.C., Ulrich Bucher, Klass, D., Silverman, P. R., & Nickman, S. L. in women with vaginal bleeding and a singleton H., & Sensky, T. (2009). Shared or discordant (Eds.) (1996). Continuing bonds: New grief in couples 2-6 years after the death of live fetus at ultrasound scan. Journal of their premature baby: effects on suffering understanding of grief. Philadelphia: Taylor and Obstetrics and Gynaecology, 26 (8), 782-784. Francis. and posttraumatic growth. Psychosomatics, Richards, J., Graham, R., Embleton, N. D., 50(2)123-130. Klass, K. (2006). Continuing Conversation Campbell, C., & Rankin, J. (2015). Mothers’ Cacciatore, J., DeFrain, J., Jones, KLC., & about Continuing Bonds. Death perspectives on the perinatal loss of a co- Jones, H. (2008). Stillbirth and the couple: a Studies, 30(9), 843-858. twin: a qualitative study. BMC pregnancy and gender-based exploration. 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Journal of Divorce & Remarriage, Cheung, S.-y., Hoi-yan, C., & Hung-yu, N. Maguire, M., Light, A., Kuppermann, M., Dalton, 53(2), 91-107. (2013). Stress and anxiety-depression levels V., Steinauer JE., & Kerns, JL. (2015). Grief after second-trimester termination for fetal Stroebe, M., & Schut, H. (1999). The Dual following first trimester miscarriage: A Process Model of Coping with Bereavement: comparison between women who conceived anomaly: a qualitative study. Contraception, Rationale and Description, Death Studies, naturally 91(3), 234–239. 23(3), 197-224. and following assisted reproduction. British Markin, R. D. (2016). What clinicians miss Stroebe, M., & Schut, H. (2010). The Dual Journal of Obstetrics and Gynaecology, 120, about miscarriages: Clinical errors in the treatment of early term perinatal loss. Process Model of Coping with Bereavement: a 1090-1097. Psychotherapy, 53(3), 347-353. decade on. Omega: Journal of Death and Dying, 61(4), 273-289. Christiansen, D. M., Elklit, A., & Olff, M. (2013). Markin, R.D. (2017). An Introduction to Parents bereaved by infant death: PTSD the Special Section on Psychotherapy for Weaver-Hightower, M.B. (2012).Waltzing symptoms up to 18 years after the loss. Pregnancy Matilda: An autoethnography of a father’s General Hospital Psychiatry, 35, 605-611. Loss: Review of Issues, Clinical Applications, stillbirth. Journal of Contemporary Ethnography, Coˆte´-Arsenault, D., & Denney-Koelsch, and Future Research Direction. Psychotherapy, 41(4) 462-491. E. (2016). ‘‘Have no regrets:’’ parents’ 54(4), 367–372. Wolfelt, A. D. (2005). Companioning the experiences and developmental tasks in Markin, R. D., & Zilcha-Mano, S. (2018). Bereaved: A Soulful Guide for Caregivers. pregnancy with a lethal fetal diagnosis. Social Cultural processes in psychotherapy for Colorado: Companion Press. Science & Medicine, 154, 100–109. perinatal loss: Breaking the cultural taboo Wonch Hill, P., Cacciatore, J., Shreffler, K.M., Doka, K. (1989). Disenfranchised grief: against perinatal grief. Psychotherapy, 55(1), & Pritchard, K.M. (2017). The loss of self: The Recognizing hidden sorrow. Lexington, MA: 20-26. effect of miscarriage, stillbirth, and child death Lexington Books. McSpedden, M., Mullan, B.. Sharpe, L., Breen on maternal self-esteem, Death Studies, 41(4), Fallon, Peter. (2014). Strong, my love. L.J., & Lobb, E. A. (2017). The presence and 226-235.

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Practitioner Perspective A Journey through Grief – Integration of Theory and Practice By Mary Spring

accompanying process. Equally important is the need for the therapist to be familiar with and have explored her or his own experiences of bereavement and loss. This article will examine significant theories that underpin bereavement and loss and explore the journey of grief from the perspective of clinical practice.

Different models and perspectives of grief Freud’s 1917 paper Mourning and Melancholia (2005) suggested that the purpose of grief was to withdraw emotional energy from the deceased (cathexis), thus enabling the griever to become detached from the loved one (decathexis). He ometimes the therapy room becomes a safe believed the bereaved person had Senvironment where the many shades of a client’s to work through his or her grief by grieving is released and honoured. As it is counter- reviewing thoughts and memories of the deceased (hypercathexis) intuitive not to mourn loss, it is necessary that and by expressing emotions, the therapist has knowledge of the phenomenon of especially pain and anger. By this bereavement and loss and the different models and painful process the bereaved could relinquish the attachment to the patterns and is able to distinguish between a client’s deceased. Unresolved grief was content and its accompanying process understood to lead to depression. Without attachment there Introduction sometimes ambiguous, are would be no sense of loss and ying and death are existential released and validated. In this Bowlby’s four Phases of Grief Dtruths. We lose people in our tender place, two hearts meet – the Model (1998) was the first theory lives to death and, someday, we listening heart of the therapist and based on empirical evidence. It too will die. Grief, bereavement’s the listened-to heart of the client. provided a predictive bereavement inescapable companion, enters Because it is counter-intuitive not framework born from an adult the therapy room when significant to mourn loss, it is imperative that person’s early life attachment - people in the client’s life die. the therapist has a knowledge of be it a secure, avoidant, anxious Thus, the therapy room frequently the phenomenon of bereavement or ambivalent attachment to becomes a safe haven where and loss and the different models the principle caregiver. In phase present-day and, sometimes and patterns and an ability to one, the bereaved experienced unexpectedly, past bereavements be able to distinguish between shock, numbness and emotional are mourned and where feelings, the client’s content and its distress. This period was then

20 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP followed by yearning and searching loss by oscillating between two for the deceased. Despair and rieving is a process hugely different coping processes disorganisation were experienced “Gof reconstructing a or strategies: “loss-orientation” and in the third phase and then, if the world of meaning that has “restoration-orientation” (1999, p. aforementioned three phases were been challenged by loss” 211-216). The former process - an completed, the fourth phase was emotion-focused coping perspective (Neimeyer, Burke, Mackay & van encountered – this was a period of - acknowledges, explores and Dyke Stringer, 2010, p. 73) reorganisation where the mourner processes the varied experiences let go of the attachment and began of feeling that accompany loss to invest in the future and in a new Recognising the complexity inherent and the continuing-relocating identity (for example, the bereaved in grief, each person’s journey of bonds. The latter process - a person no longer being part of a through the universal experience problem-focused coping perspective couple but now a single entity). of loss began to be understood as - reflects “a struggle to reorient Elisabeth Kübler-Ross’ five stage unique. oneself in a changed world without grieving process (1969), initially Worden’s Task-Based Model the deceased person” (1999, p. intended to reflect the anticipatory (2008), rejected what he saw 277) and involves adapting to the path experienced by people who as “a certain passivity” (p. 38) many external adjustments required were dying of a terminal illness, in the stage and phase models. by the loss (for example, the also detailed a sequential model. In echoing Bowlby’s attachment bereaved may now need to assume This framework was later adapted theory, Worden emphasised the a different role in the family and to assist people who mourned relevance of exploring the nature undertake tasks and duties that the loss of another - not just of the attachment between the were the responsibility of the now those who were themselves deceased and the griever and deceased). facing death - and saw the griever outlined four tasks for the therapist The social constructivist experience: (1) shock and denial that worked with the griever: (1) to perspective on bereavement (the conscious and unconscious help the client actualize the loss; proposed that “grieving is a refusal to accept the reality of the (2) to process the client’s emotional process of reconstructing a world of loss was understood as a natural pain; (3) to support the client in meaning that has been challenged defence mechanism to protect the adjusting to a world without the by loss” (Neimeyer, Burke, Mackay griever from being overwhelmed); deceased; and finally (4) to support & van Dyke Stringer, 2010, p. 73). (2) anger (with self, with the the client in finding an enduring Humans are “inveterate meaning- deceased, with others including connection with the deceased makers” (Neimeyer, 2006, p. medical personnel); (3) bargaining person in the midst of embarking 184) and in experiencing death (‘If only’ scenarios are played out on a new life. of a significant other this model in the mind); (4) depression; and Rando (2000) posited that encourages the bereaved to (5) acceptance. Significantly, when anticipatory grieving occurred when make sense of what has visited Kübler-Ross later co-authored On there is an opportunity to anticipate them, reconstruct meaning and Grief and Grieving (2005) with the death of a loved one. In the meaningfulness in their lives, and David Kessler, she proposed that midst of present-time mourning, to maintain a continuous bond with “We do not enter and leave each the bereft is supported to prepare the deceased. individual stage in a linear fashion. for the loss - this potentially Martin and Doka’s Adaptive We may feel one, then another, and offered the benefits of improving Grieving Styles Model (AGS) (2010) back again to the first one” (2005, family communication, dealing with advocated diverse coping strategies p. 18). unfinished business, reinforcing the for what they saw as different Subsequent thinking in the reality of the anticipated death, and types of grievers. In contrast to field of bereavement moved allowing respectively for the saying previously mentioned paradigms, away from the aforementioned of goodbye and the planning for the which saw the expression of predictive models that emphasised future without the deceased. emotion as an exclusive mode in the severing of bonds with the Stroebe and Schut’s Dual Process grieving, the AGS model proposed deceased and pathologized the Model of Grief (1999) similarly four different patterns in grief: the loss if one deviated from the stepped away from the stage ‘Intuitive Griever’ expresses and model or if one did not “let go” of movement in grieving. Instead, it explores grief “in an affective way” the deceased and complete the offered a dynamic framework by (Loc. 278) and benefits from social process of survival and recovery. which the bereaved copes with the support that is found in community,

Irish Association for Counselling and Psychotherapy 21 IJCP Volume 20 • Issue 3 • Autumn 2020 friendship and counselling; the 5. Is the therapist able to refer the ‘Instrumental Griever’ expresses rompted sometimes client on to another professional grief consciously or subconsciously Pby a word, a scent, a if she or he feels unable to through a cognitive, a behavioural taste, a sound or a touch, support a person in grief? and/or physical approach, for frozen memory can re- example in building a seat or a awaken and the invisible 6. Does the therapist attend flower garden which commemorates becomes visible personal therapy - a process the deceased; the ‘Blended Griever’ that offers the necessary space shares the adaption strategies to explore the therapist’s own of both intuitive and instrumental separation, divorce, bereavement journey of support? reactions and responses. The or children leaving home. Because, fourth pattern of grieving is found it is counter-intuitive not to mourn In Macbeth, Malcolm urges the in the ‘Dissonant Griever’ who loss, it is imperative that the grieving Macduff to “Give sorrow experiences conflict between therapist has a knowledge of the words: the grief that does not the experience of grief and its phenomenon of bereavement and speak whispers the o’er fraught expression. loss and the different models and heart and bids it break” (4:3. Contemporary thinking also patterns and is able to distinguish 211-212). In this liminal space of acknowledged that grief is implicit between the content of therapy bereavement and loss, and in the in the journey of ambiguous loss. and its accompanying process. It is telling and retelling of biography, As proposed by Boss (1999), equally important for the therapist a myriad of emotions of loss, all ambiguous loss “is the most to have explored her or his own legitimate and validated, may be devastating because it remains experiences of bereavement and uttered - sadness, numbness, unclear, indeterminate” (Loc. loss and to acknowledge what disbelief, a yearning to seek 49). Boss suggests that there Jeffreys (2011) gently defines as and find the deceased, anger, are two types of ambiguous loss the therapist’s “cowbells” and guilt, regret, anxiety, loneliness, - there is the physical absence the therapist’s own attachment fatigue, bodily pain, helplessness, of a loved one accompanied by a style in loss, both which stir the hopelessness, confusion, psychological presence (as in the countertransference. Questions desperation, emancipation, relief case of divorced parents or when worth addressing in this context and aching absence. Prompted people go missing) and, secondly, might be: sometimes by a word, a scent, a there is the psychological absence taste, a sound or a touch, frozen of a loved one accompanied by a 1. If each person has “a history memory can re-awaken and the physical presence (as in the case of of separations and losses” invisible becomes visible. a parent who succumbs to a stroke (Holmes, 2001, p. 14) can the ‘Seeing’ and ‘finding’ the or Alzheimer’s) and whose death is therapist distinguish between the deceased in living people is part silently and anxiously anticipated two voices of loss - the client’s of this grieving, and I am reminded and grieved long before it happens. and their own? of the tender words of Patrick In a process that is both complex Kavanagh in his poem Memory of and unresolved (until it is resolved), 2. Is the therapist “helping” or my Mother: “Every old man I see/ ambiguous loss is a death in “slow enabling the grieving client to Reminds me of my father/When he motion” (Kübler-Ross and Kessler follow the unique and individual had fallen in love with death/One (2005, p. 194). movement of loss and unearth time when sheaves were gathered”. his or her wisdom in loss? A Gestalt-type empty chair may The journey through grief and loss be used; the client encouraged to from the perspective of clinical 3. Does the therapist offer the directly address the deceased in practice mourning client a structured and the first person and in the present “So, we live here, forever taking safe environment to feel, release tense or speak the imagined words leave,” poignantly observes Rilke and contain the grief? of the deceased. (1989, Loc: 2850). Perhaps The client’s euphemisms loss emanates from nearly every 4. Can the therapist respect and associated with death (for example: therapeutic session, nestling within celebrate a client’s differing “kicked the bucket”, “pushing up the exploration of life stages, cultural and spiritual belief daisies” and “gone to a better aging, physical decline, change in systems regarding death? place”, are also worth pondering; work circumstances, relationships, new metaphors can be created.

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Grief can also be voiced and not come to a conclusion. The released in other ways, such as t times, bereavement client will invariably need time to in the exploration of dreams, in Aand the various hues dismantle what Grosz notes as the expressive art, in journaling and in of loss speak quietly like fantasy and fiction of mourning, writing a letter to the deceased. a zephyr; at other times that “we can love, lose, suffer and The exploration of a client’s pronouncing with the then do something to permanently felt sense and the accompanying volume of thunder end our sorrow” (2014, p. 209). imagery can be revelatory. The The loss remains a loss but is client’s body always speaks and, experienced at a different level of very often, unbeknownst to us, base” (Holmes, 2001, p. 14) of intensity as time passes. Freud’s speaks from the disowned, the therapy, the reflective therapist might evocative reflection (1929), in a numbed, and lost feeling self. encourage and challenge the client letter to his friend the psychiatrist The therapist will be mindful of to forego “our hunger for mastery” Ludwig Binswanger, who was the client’s silence, the breath, (Boss, 1999: Loc. 1043) and see grieving the death of his eldest the tone, the constricted throat bereavement and loss as an implicit son, captures this truth: “No clearance, the power and healing in companion in life’s continuous matter what may come to take the escaping sighs, the journeying journey of transition and change. its place, even should it fill that hands, the folded arms, the rigid For some, however, death and place completely, it yet remains pose, the averting eyes, the body’s the journey of grieving is profoundly something else. And this is how energy or inertia, and so much complex. Lives and families it should be. It is the only way of more. Gently, non-judgemental are robbed in the most tragic perpetuating a love that we do not awareness of the body can be of circumstances and the loss want to abandon”. brought to the awakening attention can be deeply and acutely life- In the milieu of loss, the client’s of the client, he or she learning to lasting. Consider for example, the need invariably is ‘Is my experience explore the sense-filled experience sometimes disenfranchised grief, normal?’ and, in an affirming and own the intuitive insight and as in death by suicide, death by response, the therapist may wisdom the body reveals. violence, death of an unrecognised encourage the practice of healthy “One cannot deal with a loss same-sex partner, death of an ex- coping techniques, such as trusting without recognizing what is lost” spouse. in the healing power of time, (Klass, Silverman & Nickman, Consider the often, silent grief resting, seeking re-engagement 1996: Loc. 897). A client’s losses in still births, miscarriages and in routine work, feeling one’s may be many. Recognising this, the abortions. Such pain invariably vulnerability and expressing the sensitive therapist might empower makes the search for meaning reality and the significance of the the client to awaken to the primary much more difficult. Where there loss in various forms. loss of the attachment, the may be an absence or exclusion accompanying secondary losses from formal rites, ritual and Personal thoughts and the stirring of old losses that symbolism can be respectfully As I reach my 60th birthday, yearn to be heard in the present. evoked in therapy - the therapeutic bereavement and loss are constant Surrendering “to the mystery of space offering a place where the companions. My first encounters grief” ( Wolfelt, 2003, Loc. 1373), relationship and its loss can be with death or near-death occurred the fragmented self can be found honoured and where “a sense when, as a sick little baby, I in the response to questions such of reconstruction and renewal” spent many months in both as “What do you miss about - ?”, (Neimeyer, 2006, p. 186) can be Crumlin Hospital and University “What do you not miss about - ?”, enabled. College Hospital Galway. At times, “What have you lost?” and “What The rhythm of bereavement and bereavement and the various hues do you mourn that never happened loss (and consequently the rhythm of loss speak quietly like a zephyr; in the relationship”. of therapy) is invariably uneven, at other times pronouncing with the Described by Yalom as “the unpredictable and unique for volume of thunder. Living, as we all wound of mortality, the worm at the each person. Holidays, birthdays, do, in the shadows of leave-taking core of existence” (2008, p. 274), anniversaries, the oftentimes and loss, and reminded of John bereavement and loss may awaken disorientating shift in the family McGahern’s moving depiction of his existential questions regarding dynamic, and subsequent deaths, continuing bond with his mother life’s predictability, our mortality, our potentially trigger an awakening who died when he was nine years finiteness. In the “temporary secure of jagged emotion. Grief does old: “When I reflect on those rare

Irish Association for Counselling and Psychotherapy 23 IJCP Volume 20 • Issue 3 • Autumn 2020 moments when I stumble without loss is a journey of two connecting and in the background” (2005, p. warning into that extraordinary hearts - the listening heart of the 158). The ever-becoming journey sense of security, that deep therapist and the bereaved heart of continues. peace, I know that, consciously or the client. The therapist can be an unconsciously, she has been with “exquisite witness” who “enters the me all my life” (2006, p. 272), I sacred space between two human Mary Spring momentarily pause to honour my souls” (Jeffreys, 2011, p.3). Here late mother and father, Mary, the in the unfolding journey of ever- sister I never saw, my good friends changing life, mystery unfolds in Mary Spring is an accredited Jemma and Jacqui, my fellow-year the harrowed heart. Sense can be counsellor-psychotherapist with the head John, and Sara, a former pupil. made of absence and the organic IACP. She works in private practice flow that is inherent in bereavement in Galway city and is a tutor/lecturer Conclusion and loss can be embraced. New with the International College Theories referred to in this article life-fulfilling identities can emerge for Personal and Professional suggest that there is a journey - the client awakening to its own Development (ICPPD) in Athlone of grief to travel in bereavement innate wisdom and power, and and Galway. Mary previously worked and loss. Early-stage theorists learning, as suggested by Kübler- in second-level education and can considered a linear, even staccato- Ross and Kessler, to “Live with it be contacted at marymspring@ like movement, towards negotiating [the loss], both in the foreground gmail.com loss and achieving separation and detachment. Newer paradigms and REFERENCES contemporary therapy recognise, not a sequential journey, but a Boss, P. (1999). Ambiguous loss: Learning to live John McGahern, J. (2006). Memoir. London: with unresolved grief. [Kindle version]. Retrieved Faber and Faber. journey that honours the unique from http://www.amazon.uk Neimeyer, R. A. (2006). Bereavement and the pathway of each griever. It is a Bowlby, J. (1998). Attachment and loss: Vol. 3. Quest for Meaning: Rewriting Stories of Loss journey of the heart, the mind, the Loss: sadness and depression. [Kindle version]. and Grief. Hellenic Journal of Psychology, Vol. 3 Retrieved from http://www.amazon.uk (2006), pp. 181-188. Retrieved from https// body and the soul. Doka, K. J. Martin, T. L. (2010). Grieving www.researchgate.net Purpose and meaning are beyond gender: Understanding the ways men and Neimeyer, R. A., Burke. L. A., Mackay, M. M., found in the tasks that require women mourn. Revised Edition. [Kindle version]. van Dyke Stringer, J. V. (2010). Grief Therapy Retrieved from http://www.amazon.uk and the Reconstruction of Meaning: From attention following the death of Freud, S. (2005). On murder, mourning and Principles to Practice. Journal of Contemporary a loved one. Social connection melancholia (S. Whiteside, Trans.). [Kindle Psychotherapy. Vol. 40 (2010) pp. 73-83. version]. Retrieved from http://www.amazon.uk Retrieved from https//www.researchgate.net with others is valued and grief Freud (1929). Letters from Freud to Ludwig O’Donohue, J. (2007). Benedictus: A book of is no longer seen exclusively as Binwanger April 11 1929. Retrieved from blessings. London: Bantam. https://www.pep-web.org a negative life event; instead, it Rando, T. (2000). Clinical dimensions of can in time be a transformational Grosz, S. (2014). The examined life. London: anticipatory mourning: Theory and practice in Random House. working with the dying, their loved ones, and experience. The telling of narratives Holmes, J. (2001). The search for the secure their caregivers. Michigan: Research Press is seen as healing. A continuing base: Attachment theory and psychotherapy. Company. Hove, East Sussex: Routledge. bond with the deceased, albeit Rilke, R. M. (1989). ‘The Eighth Elegy’, in Jeffreys, J. S. (2011). “The Exquisite Witness Mitchell, S. (Ed). The selected poetry of Rainer different from the earlier lived Grief Care Provider”. Adapted from Helping Maria Rilke [Kindle version]. Retrieved from connection, is encouraged - a grieving people – when tears are not enough: A http://www.amazon.uk handbook for care providers, 2nd Edition. New Shakespeare, W. Macbeth. (1977), G. K. bond that acknowledges the York: Routledge. Retrieved from https://www. Hunter, (Ed). New Penguin Shakespeare. griefcareprovider.com irreversible nature of death yet England: Penguin. Kavanagh, P. (1969). Soundings: Leaving Stroebe, M. & Schut, H. (1999). The dual also honours relationship and cert poetry interim anthology. Taken from the memory. Interdependence in death poem “Memory of my Father”. Dublin: Gill and process model of coping with bereavement: A Macmillan. decade on. Omega Journal of Death and Dying, is sustained and in the words of the 61, (4). pp. 275-291. Retrieved from https// Klass, D., Silverman, P.R., & Nickman, S. www.researchgate.net poet and mystic John O’ Donoghue L. (Eds.). (1996). Continuing bonds: New in his poem For Grief: “You will understandings of grief. [Kindle version]. Wolfelt. A. (2003). Healing a spouse’s grieving Retrieved from http://www.amazon.uk heart: 100 practical ideas after your husband learn acquaintance with the or wife dies. [Kindle version]. Retrieved from Kübler-Ross, E. (1969). On death and dying: http://www.amazon.uk invisible form of your departed”. What the dying have to teach doctors, nurses, Within each of us the tension of clergy and their families. 50th edt. [Kindle Worden, J. W. (2008). Grief counseling and version]. Retrieved from http://www.amazon.uk grief therapy: A handbook for the mental health practioner (4th Ed.). [Kindle version]. Retrieved our impermanence nestles between Kübler-Ross, E. & Kessler, D. (2005). On the inhalation of our first breath and grief and grieving: Finding the meaning of grief from http://www.amazon.uk the exhalation of our last breath. though the five stages of loss. London: Simon & Yalom, I. D. (2008). Staring at the sun. [Kindle Schuster. version]. Retrieved from http://www.amazon.uk Counselling and psychotherapy in

24 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Noticeboard Cathaoirleach’s letter to members Autumn 2020

Dear Member, PR company Fuzion for their work in bringing the campaign to fruition. I hope you have adapted to this unique situation that we find As you may have read in my recent email to members, ourselves in. It has indeed been the decision was made to host our 2020 Annual a period of great change for all Conference virtually on the 17th October. This will be of us. The lockdown has created the first time that we will host the conference online. a strange new world. I would However, we are not alone in this regard and many like to extend my sympathy to organisations like us have done the same thing. The any of our members who were board has decided, under the current circumstances, unfortunate enough to catch the not to charge a fee for the annual conference this year virus and extend my condolences to any that may have and full details of the line-up of speakers is contained lost a loved one to the illness. in this edition.

It was a challenging time for all of us, and indeed people’s experiences didn’t seem to match. I had some friends and colleagues who thrived in the lockdown, while others may have felt isolated and frightened. I’d like to extend my thanks on behalf of the Board of Directors to the IACP Committees, our Members and staff for adapting so readily to the unique and unusual situations forced upon us by the lockdown. It was not easy, and I know that some people found the transition to a more digital/ remote working life to be very difficult. I know that I often found the hours of video conferencing to be very taxing on my patience and concentration, but it was a challenging necessity. It is incredibly important for us as counsellors and psychotherapists to provide our services to our clients and to keep in touch with our colleagues and supervisors, and we were lucky that we lived in an age where technology allows us to do that so readily.

I was pleased to see such a positive reception to our Look After Yourself campaign, it seemed I couldn’t pick up a paper or use the internet without seeing the IACP mentioned in it. It was joy to attend the launch and meet our ambassadors and Joe Caslin in person (from an adequate social distance of course). We hope that the campaign serves to encourage young men who are traditionally reluctant – at least more than women - to seek counselling. I’d like to thank Lisa Molloy, Hugh O’Donoghue and our external Ray Henry as pictured in his interview with the Irish Sun

Irish Association for Counselling and Psychotherapy 25 IJCP Volume 20 • Issue 3 • Autumn 2020

Cathaoirleach’s Letter to Members

(L - R) Ray Henry, IACP CEO Lisa Molloy, Artist Joe Caslin, Shane Carthy, IACP Vice-Chair Bernie Hackett at the Look After Yourself Launch

On the other hand, we hope to host a physical AGM Writing on IACP services, I am very happy to welcome in 2020, as previously advised the date has been our new Ethical Advisor Marie Kealy. Marie will be changed from the 16th October to the 5th December. available for 4 hours each week to respond to ethical The venue, the Galway Bay Hotel will remain the same queries from IACP members and will aid IACP members unless Government guidance in relation to indoor on Ethical issues. I know that Marie will provide a gatherings does not allow for this. I look forward to valuable service to members, and I know that many of seeing some of you (virtually) at the Annual Conference you have had positive interactions with her already. and hopefully in person at our AGM. I’d like to wish you all the best as we move into a post- We commissioned a member survey during the lockdown world and know that we can continue as an lockdown to hear how our members were faring organisation to rise to meet the various challenges with converting their practice to a digital space and that face us in the upcoming months. I hope that you how they’ve found IACP remote services. I’d like to are all faring well, and I look forward to meeting with thank the members who took the time to complete you in whatever way that may be in the future. the survey – 900 – the resulting data (at the time of writing) is being analysed and reviewed by Research Mise le meas, Officer Ellen Kelly and the team at B & A. We’re very much looking forward to seeing what our members have had to say, and we’re excited to share the results with you in the upcoming months. Ray Henry, Cathaoirleach, IACP

26 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

A message from the Chief Executive A Message from the Chief Executive Autumn 2020

In addition to preparing for our return to the office, Dear Member, the month of July marked the launch of our Look After I write this as we come to the Yourself Campaign. The aim of the campaign is to end of a summer unlike any encourage young men in Ireland to seek counselling. that we have experienced in our On 7th July, Chair Ray Henry, Vice-Chair Bernie Hackett, lifetimes. As our country begins and I along with our ambassadors Dublin’s GAA’s Philly to emerge from the long period of McMahon and Shane Carthy, assembled (at a distance) restrictions, we are all moving into in Dublin City Centre to watch the unveiling of the mural, yet another period of adaptation commissioned by the IACP and created by artist Joe with many of you returning to Caslin. I have been very impressed with the amazing seeing clients face-to-face and art work that Joe has delivered for other advocacy with the staff returning to office-based work. campaigns in the past, and I was delighted at the reveal to see such an impactful and thought-provoking mural We made the decision to return to office-based working which serves as a fitting homage to the work of our in our premises in Dún Laoghaire, Co. Dublin on the 20th members. I’d like to thank all of those involved with the July. We have prepared our office for safe reoccupation campaign and for those of you who may not have seen by staff and we have put in place appropriate protocols the extensive media coverage please visit the website and measures within our office to enable everyone to for more information. Despite the restrictions over work safely. The IACP are following the government the last number of months, work continued via email, guidelines to maintain social distancing for staff in telephone and virtual meetings and in May, just before the office. For this reason, staff have been split into the Programme for Government talks, I was contacted 2 groups, each group on alternate shifts, working by James Browne, TD. The purpose of the call was to every second day in the office and continuing to work request the IACP to submit proposals for a nation-wide remotely on the alternative days. The IACP phone lines school counselling support initiative for schools. This will be open between the hours of 9:30 a.m. and 1:00 invitation came on foot of our previous calls for such p.m. Monday to Friday. Our approach adheres to the Government’s Return to Work Safely Protocol. We remain informed of the latest measures introduced by Government and will act on any advice issued as a result. It is difficult to have to keep such a distance from my colleagues, but we all know that this is in the best interest of everyone’s safety and well-being. The office is currently closed to visitors and all Committee meetings will continue to run online but we hope that it won’t be too long before we can welcome our valued members to the (Clockwise from Bottom Left) Minister of State for Mental Health and Older People Mary Butler, TD, Emily Flaherty Dept. of Health, Tom O’Brien, Dept. of Health, IACP Chair Ray Henry, Communications and Media office again. Officer Hugh O’Donoghue, CEO Lisa Molloy on video conference on 11th August

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A message from the Chief Executive

(L - R) Lisa Molloy, Shane Carthy, Philly McMahon, and Joe Caslin supports for second-level school children. Although change in her career path and has stepped down from our proposals were not specifically referenced in the her role as Executive Administrator. Emma Gribben, Programme for Government, we welcome the general who has worked in our Accreditation Department for reference to increased mental health supports for the last 18 months has stepped into the role vacated schools. We were pleased by the approach and invitation by Hannah and Laurie Dool has joined the IACP staff to submit and the IACP will continue to lobby on this and as Emma’s replacement in the role of Accreditation other matters in the interests of our members. Officer. I, on behalf of us all would like to wish Hannah the very best of luck in the next chapter of her life, she In fact, we have secured a further opportunity to discuss will be a wonderful addition to any team. I would like to this proposal along with other matters when we meet congratulate Emma and wish her the very the best in her with the new Minister for Mental Health and Older new role and I would also like to welcome Laurie to the People, Mary Butler, TD via video conference call on the IACP team. I know that you’ll all make Laurie feel very 11th of August. We are very happy to be able to secure welcome to the IACP when you meet her (on the phone, a meeting with the Minister so quickly. We are keen to virtually or in person) over the coming months. make her acquaintance and to continuing the dialogue between the IACP and the Department of Health. This is I have been and I remain so impressed by the resilience, a very important relationship for us to uphold, and we are adaptability and empathy demonstrated by you our looking forward to engaging with Minister Butler on behalf members and our staff over the recent months. It has of our members. been an unprecedented and difficult time, but what has been borne out of all this has been solidarity and Another area where we have been consistently pushing mutual support. I am very proud of our organisation, our for changes on behalf of our members is with the HSE dedicated staff, board and committee members and all regarding their recruitment criteria for counsellor and of you in the wider membership who have risen to these psychotherapist posts. I was very pleased to see that challenges in the interests of your clients. I know this following numerous communications to the HSE, that a pandemic is far from over but this has made me very number of vacancies in the HSE Addiction Service were optimistic for what the future holds for the IACP, and I advertised recently and the advertisement includes look forward to working as your CEO as we face into this under professional qualifications that applicants be new chapter. “accredited as a counsellor/psychotherapist with the Irish Association for Counselling & Psychotherapy (IACP)”. I look forward to speaking to you all again very soon. I see this, albeit long-awaited, as a positive first step and we will continue to engage with the HSE regarding the further inclusion of accredited IACP members in future recruitment campaigns. As we return to working in our Lisa Molloy physical premises, I have some staff announcements Chief Executive, IACP to share with you: Hannah Garland has decided on a

28 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Noticeboard

Counselling, Supervision and Training in Ireland and the US During COVID-19 Conference

Once again, we’re inviting IACP Members to explore Counselling Practices in the US and in Ireland. This year the conference will (L - R) Ray Henry, Dr. Ted Remley, University of Holy Cross, New Orleans, and Lisa explore practice in the era Molloy at 2019’s Conference of COVID-19. The conference will be held via Zoom on 25th September 2020, between 4pm and 7pm. (3 Reminder regarding meeting CPD points) The University of Holy Cross, New Orleans, Louisiana, USA, DePaul University Chicago and IACP supervision and CPD will present American and Irish speakers sharing their requirements for accreditation/ experiences of best practice but also the challenges of conducting counselling, supervision and training re-accreditation during during the pandemic. Speakers will include academics COVID-19 pandemic and counselling and psychotherapy practitioners. The event is open to all IACP Members (ticket price With regard to the unprecedented challenges faced only €15). To book your place, please visit the events by Members during the COVID-19 outbreak, we would section of the IACP website. like to give reassurance that IACP will support all who struggle with full compliance regarding supervision and CPD requirements. Members who are not currently in a position to see A Fond Farewell – clients and are not able to attend monthly supervision Ger Haskins will be able to seek discretion at the time of applying for accreditation/re-accreditation. Please provide We would like to announce the a letter with your application for accreditation/re- retirement of Geraldine Haskins accreditation stating the reason for lack of client from her role as Administration work/supervision during this time and it will be taken Officer in IACP at the end of into consideration by the Accreditation Department/ September this year. Accreditation Committee. Geraldine has been working for the IACP for the last Regarding CPD compliance during the COVID-19 20 years. During her many years in this role she has outbreak, IACP now has free CPD content available dealt with new Student, Pre-Accredited, Affiliate and on the online portal. For members who struggle with Organisation members as well as dealing with finance technology and are not able to access this free online administration for the organisation. CPD, it will be possible to seek discretion in relation The IACP Board of Directors and Staff would like to to lack of ability to fulfill IACP CPD requirements thank Geraldine for the many years of loyalty and in 2020. A letter with rationale for such discretion commitment she has shown to the IACP. should be supplied to the Accreditation Department at the time of re-accreditation or annual audit. Geraldine will be greatly missed by the staff, Board members and IACP members and we would all like to For more information on other COVID-19 related wish her all the best upon her retirement. matters, please visit FAQ section on IACP website.

Irish Association for Counselling and Psychotherapy 29 IJCP Volume 20 • Issue 3 • Autumn 2020

IACP Noticeboard IACP Virtual Conference 2020 Saturday 17th October The IACP Board of Directors invites you to the Fifth Annual IACP Conference, which will be held virtually for the first time. The theme this year is ‘Equality, Diversity, and Inclusion’. 6 CPD points will be awarded for attendance and as previously advised there will be no cost for IACP members to attend the virtual conference this year. The Conference will be opened by IACP Cathaoirleach, Ray Henry, followed a presentation by our first guest speaker Dil Wickremasinghe,“Inspiring Change in Self and Society”. Speakers Dil Wickremasinghe A short comfort break will be followed by a presentation from our second guest speaker, Eoin Dil Wickremasinghe has one vision and Stephens, ‘Working Therapeutically with Adult Autistic that is to create an inclusive and equal Clients: A Neurodiversity Perspective.’ Ireland where all residents can live a fuller and more authentic life. For a decade she was Eoin’s session will be followed by the IACP Awards a Social Justice and Mental Health broadcaster and Ceremony. journalist and presented the award-winning weekly Following a 45-minute lunch break during which programme “Global Village” on Newstalk 106-108. there will be networking opportunities - there will She then presented “Sparking Change with Dil” on be a presentation from our third guest speaker, the Head Stuff Podcast Network and now presents the Myira Khan, who will present ‘Diving in the Deep “Insight Matters - Inspire Change in Self and Society” End: The Reflections and Ripples of Power, Privilege podcast. In addition, Dil is also a regular contributor to and Oppression in the Counselling and Therapeutic Irish media and an international speaker. Profession’. Dil is a social entrepreneur and co-founded the mental Our final presentation will be from guest speaker health support service Insight Matters with her wife Paraic Barnes, with his presentation ‘Vision without Anne Marie Toole in 2013. Along with a team of 75 sight: A lens for looking at dimensions of equality, psychotherapists they provide low cost, inclusive diversity and inclusion.’ and culturally sensitive counselling, psychotherapy and wellness services to over 500 clients per week. There will be a live Q&A session facilitated after Together they hope to “inspire change in self and society.” every presentation. There will also be a function for attendees to ask questions and make comments In 2018 Dil returned to college to train as a Counsellor during the presentations. and Psychotherapist. She is currently attending the

30 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Noticeboard

B.A. Counselling & Psychotherapy in Dublin Business Myira Khan College. In 2014 she was honoured with the Frederick Myira is a BACP Accredited Counsellor, Douglass Award as part of the Lord Mayor’s Awards for Coach and qualified Supervisor, her outstanding contribution to civic life. In 2015, along working in private practice, under her with 9 other inspiring women, Dil won the Irish Tatler organisations ‘Myira Khan Counselling’ Woman of the Year Award for her work as a Marriage and ‘Grow To Glow’. Myira also delivers workshops Equality campaigner. In 2006, Dil required urgent mental and events internationally and is a regular speaker health support but it took her ten attempts to finally and facilitator at national conferences. In 2017, find an inclusive counselling service which helped Myira helped establish the Leicester Centre for her feel safe to begin her inward journey. Since then Psychodynamic Counselling, which offers counselling, she has been advocating for the Irish counselling and counselling training and CPD workshops. psychotherapy community to create a more inclusive Myira is the Founder of the Muslim Counsellor and and culturally sensitive therapeutic space. In her talk, Psychotherapist Network (MCAPN). MCAPN connects she will share her own experience, highlight how the Muslim counsellors, therapists and psychologists, via current core training needs to evolve to capture the networking, events and CPD opportunities and raises broad diversity of our Irish society and will provide insight visibility of Muslim practitioners via their Counselling into how practitioners can create a more inclusive, Directory. culturally sensitive and welcoming therapeutic space. She will explore the intersectionality of ethnicity, sexual Myira was a Trustee of BACP (2016-2019). As a orientation, gender identity and coloniser-settler ancestry role-model, Muslim and East African-Asian counsellor, that clients may bring to the therapeutic space and how supervisor and coach Myira represents diversity a practitioner must continually strive to be aware of their within the profession and promotes counselling to own privilege and unconscious bias to support the client minority and marginalised communities, to break the to feel safe in the therapeutic relationship. stigma of mental health and therapy. For her work Myira was awarded the Mental Health Hero Award Eoin Stephens in 2015. Eoin Stephens is a leading Counsellor/ Psychotherapist and lecturer/trainer, Paraic Barnes who has worked in the area of therapy Paraic Barnes B.Ed BSC (Psychology) and mental health for over 30 years, BSc (Counselling) MSc Education and specialising in a Case Formulation approach to Cognitive Training) Behavioural Therapy. He has been particularly involved Paraic is a practising counsellor/ in the area of behavioural addictions such as sexual psychotherapist, an accredited member of the IACP addiction, and in the relationship between addictions and and a part-time lecturer with PCI College. Prior to mental health problems such as anxiety and is a co- losing his sight in 2011, he worked in the areas of founder of Dual Diagnosis Ireland. Education and Psychology where his remit included He works in private practice in Dublin and Naas, and extensive mentoring and coaching roles. Since 2011, lectures at PCI College, where he previously held the he has continued this work and achieved a BSc (1st position of College President. Eoin has served on IACP honours) in Counselling and Psychotherapy. He is a committees, including a period as Vice-Chair, and was strong advocate in promoting a broader understanding awarded the Carl Berkeley Memorial Award in 2010. of disability and has published articles on diversity and inclusion in national newspapers. He has been guest Eoin is currently focusing a lot of his attention on lecturer at university inclusion symposiums and is a understanding the problems faced by autistic adults & regular contributor on local and community radio where their specific therapeutic needs. He is autistic, having he supports the work of well-known charities such as made the discovery in late adulthood. the NCBI and Irish Guide-dogs.

Times for the conference will be available on the booking link in the events section of iacp.ie

Irish Association for Counselling and Psychotherapy 31 IJCP Volume 20 • Issue 3 • Autumn 2020

IACP Noticeboard

IACP Research Bursary – Call for Applicants

We can now confirm that the Board of Directors has ratified an IACP Research Bursary for 2020 - 2021.The Research Bursary of €3,500 will be awarded to an IACP Member carrying out Doctoral Research (PhD/Professional Doctorate) which is deemed to be relevant to IACP’s strategic aims – promoting research in the counselling/ psychotherapy professions. The Research Bursary is to help to cover the direct research expenses involved in the completion of doctoral research (such as materials and equipment costs; software and hardware critical for the research; archival course of their research that is covered by the bursary research costs; reasonable travel and conference costs • The successful applicant will be expected to submit pertinent to the research; publishing and write-up costs). an annual report to update the IACP on their progress IACP members at an advanced stage of their research until project completion are now invited to apply for this Bursary. Applicants will be expected to provide: • The successful applicant will be expected to cite the support of the IACP on any publications arising out of • A 500-word proposal about their research, detailing their doctoral research progress to date and the trajectory for completion. The • The successful applicant will be expected to submit proposal should include: the aims of the research; the an article based on their research findings to the Irish methodology; the proposed contribution to the field of Journal of Counselling and Psychotherapy, within one counselling/psychotherapy, plans for dissemination year of project completion and how an IACP research bursary would help with completion • The IACP will not take responsibility for promotion, recruitment or dissemination of the research or • Ethical Approval from the appropriate academic body commit to any other action other than listed above • CV of the applicant Completed applications should be sent by e-mail to Dr Additional Information and Terms and Conditions: Ellen Kelly at [email protected] by Friday, September 18th • The IACP website will host information about the 2020 with the subject line: “IACP Research Bursary”. Bursary and the successful applicant’s research Applications will be reviewed and adjudicated on by the details Research Committee and recommended for approval to • The successful applicant will be expected to provide the Board of Directors. The successful applicant will be details of the expenses they encounter during the notified in October 2020.

COVID-19 Member Survey – Coronavirus Thank You COVID-19 Thank you to all who took the time to complete the COVID-19 Member Survey. There was an excellent Member Survey response rate with 20% of members completing the survey. Data analysis is currently underway, and we look forward to sharing the findings with you in due course.

32 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Noticeboard Meet the Board of Directors We asked the IACP Board of Directors to share with us their experiences as an IACP Member. The full interviews will be published on the IACP website. The remaining Board of Directors’ interviews will also be published on the website and in a future edition of the IJCP.

Ray Henry, IACP Board of Directors’ Cathaoirleach What made you interested in a career in Counselling/Psychotherapy? In the mid 90’s, I was working as a Social Care Manager in a residential home for young people and was obligated to do professional development that would enrich or top up what relevant knowledge I already had in the area of working with young people in care and in the management of staff. Though I did not have much interest in studying counselling at that time i.e. 1996, an opportunity presented itself whereby I was accepted onto the two-year Counselling course in Trinity College. The truth be known, I was more interested in getting into Trinity College than on the counselling course. However, the subject on Staff Management as part of the course did appeal to me. The plan was that at the end of the first year I would jump ship as this subject was to be delivered in the first year. This I know was a bit extreme, but it was what it was, an introduction to counselling and a place in the historical Trinity College. That is how and why I ended up on the counselling course and to my amazement and astonishment from the beginning I enjoyed every aspect of the course through my fellow students to the subjects studied and the relevance of the profession to Irish society. I have no doubt the sequence of events was meant to be and was a major driving force behind my involvement in IACP

Bernie Hackett, IACP Board of Directors’ Vice-Chair What do you think the future holds for our profession? The move to regulate the profession, while moving very slowly, will no doubt be in force within the next few years, all counsellors/psychotherapists will require a license to practice and members of the public who wish to access therapeutic help can be reassured that the therapist they choose is trained and is qualified to hold that license. However, there is an inherent danger in the demand for accountability and professionalism that academic qualifications may overshadow, namely: the therapeutic use of self by the therapist remains the conduit of healing. When regulation does happen, I believe that IACP will continue to have a very significant role, in terms of providing quality CPD, working with course providers, monitoring standards of training, and up-to-date research for the benefits of its members.

Eamon Fortune, IACP Board of Directors’ Member What advice would you give to the new generation of IACP Members? I would say ‘embrace the experience and the learning’. Especially the self-awareness. The more you integrate and network with other Therapists, the more you will learn. Experimental learning has always been my favourite way of gaining information. As a Therapist, you can be isolated when working in private practice, so networking and learning from each other can be very valuable but also fun.

Irish Association for Counselling and Psychotherapy 33 IJCP Volume 20 • Issue 3 • Autumn 2020

IACP Noticeboard

Jade Lawless, IACP Board of Directors’ Treasurer What skills/attributes are essential for working in this profession? The essential skills of the counsellor are known to all who will be reading this but for me, the one worth highlighting is a certain level of adaptability. This could be called open-mindedness, it could be called flexibility, therapeutically it could be reframing. This, to me, is an important part of the work as the nature of this work can be so unpredictable. Whether that be on a clinical level, in relation to what might come up in the counselling room, how you might be challenged to work through a client issue within supervision, what areas you need to upskill in for CPD development or on a practical level, how you negotiate room rental, organisational policies or even a global pandemic! An open mind to a changing landscape can mirror a solidness that is reassuring to our clients.

Peter Ledden, IACP Board of Directors’ Member What key piece of learning has the Pandemic taught you? I have found the pandemic to be enlightening personally, as it was a leveller of all us human beings on the planet. It allowed for reflection, appreciation, adaptability, hope and the ability to transcend fear. In my own case as an EAP provider for many nursing homes and hospitals such as the Mater, St James and the HSE, I had the responsibility of working directly with all frontline staff affected by the COVID-19 crisis and I guess my key piece of learning is that humans can overcome adversity when we think positively and have adequate supports such as counselling in place.

Liz O’Driscoll, IACP Board of Directors’ Member What made you interested in a career in counselling/psychotherapy? I suppose I have always been in the people/relationship business in that I started my work life as a hairdresser and went on to open some salons so worked with teams as well. I found that people often took the opportunity to “offload” personal experiences that they were challenged with. In the meantime, I was doing some voluntary work with a listening service in Dublin and I really liked the training so decided to go ahead and do a cert in NUI in counselling and psychotherapy. What followed, was 10 years of study and part-time practice that culminated in a masters in cross-professional supervision. I have always had the sense that “the human condition” needs to express itself and how important it is for the process of therapy to facilitate this in a safe trusting environment. While many theories and models of practice have become fashionable at different times, it is essential that the relational piece is nurtured (however short) for change to happen.

IACP in the Media IACP CEO Lisa Molloy’s letter to the editor regarding VAT Exemption and Counselling was published in the Irish Times on 8th June. The results of IACP’s recent omnibus survey question was featured in articles published in the Irish Examiner and Her.ie. On 7th July, IACP launched its Look After Yourself campaign, this resulted in a great deal of media coverage which can be read on iacp.ie news section.

34 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Accreditations

First Time Accreditation

Agapi Kapeloni Dublin 14 Linda Gillen Dublin 16 Agnieszka Maria Kulczycka-Dopiera Poland Lisa Quinlan Co. Carlow Aisling McGovern Nolan Dublin 16 Loretta Noone Co. Kildare Aisling O'Loughlin Co. Clare Lorraine Mooney Co. Louth Aisling Young Co. Dublin Louise Lordan Dublin 3 Alina Gavrilas Dublin 15 Mairead Kafe Co. Meath Andrew O'Shaughnessy Dublin 7 Mairead Kirby Dublin 7 Andrina Monaghan Co. Dublin Maria Lawton-Murray Co. Galway Angela Buckley Dublin 4 Maria Estefania Garcia-Moratilla Dublin 13 Annalisa Nardini Co. Kildare Marie O'Connor Co. Sligo Anne O'Brien Dublin 11 Marie Cumiskey Co. Wexford Anne Doyle Co. Kerry Mark Tolan Dublin 15 Anne Quinn Dublin 5 Mary Gaynor Co. Carlow Aoife Douglas Co. Cork Maryrose Staunton Co. Kilkenny Audrey O'Sullivan Co. Kerry Mia Christina Doring Co. Dublin Bernadette Carew Co. Westmeath Michael Holden Co. Tipperary Breda Brady Co. Westmeath Mona Fortune Co. Wexford Brian Kenny Dublin 11 Natasha O'Keeffe Co. Tipperary Brina Casey Dublin 8 Niall Connolly Co. Wexford Briona Sheils Dublin 15 Niamh Brooks Co. Cork Carol Boland Co. Wexford Niamh O'Connell Dublin 7 Carolyn Power Co. Cork Noelle Frances Elliot Co. Laois Colette Kehir Co. Kildare Orla Hanley Co. Roscommon Craig McCullogh USA Pamela Keady Co. Galway David Judd Dublin 5 Patrick Cummins Co. Tipperary Declan Nolan Dublin 12 Paul Mulcahy Co. Cork Denis O'Sullivan Co. Kerry Richard County Dublin 22 Denise O'Reilly Dublin 5 Robert Rackley Co. Limerick Denise Vickers Dublin 3 Ronan Tiernan Co. Dublin Derek Smith Co. Kilkenny Rosaleen O'Leary Co. Cork Edel Lawless Co. Galway Sandra O'Keeffe Co. Waterford Emma Cruise Co. Dublin Sara O'Donnell Dublin 3 Evelyn O'Connell Dublin 9 Sarah Walsh Dublin 15 Geraldine O'Connor Dublin 6W Sarah Edwards USA Grace Harrison Co. Clare Seamus Walsh Co. Dublin Helen May Co. Kildare Sharon O'Keefee Co. Cork Helen O'Donnell Co. Tipperary Sheila Sheahan Co. Meath Helen Brennan Dublin 12 Siobhán Carr Dublin 13 Helen Carter USA Stephanie Jayne Delaney Dublin 18 Jackie Byrne Dublin 18 Stephanie Golds Co. Waterford James Foley Dublin 22 Sue Dunne Co. Meath Jane Palmour Co. Kildare Suzanne Larkin Co. Westmeath Jane Justin Co. Offaly Theresa Dermody Dublin 13 Joanne Magee Co. Dublin Thomas Reid Co. Cork John T Carroll Co. Roscommon Tomás Fitzpatrick Dublin 12 Joy Conlon Co. Louth Vanessa O'Brien Dublin 12 Karen Hegarty Co. Waterford Yvonne Colgan Dublin 15 Laura Bustarviejo Dublin 3

Irish Association for Counselling and Psychotherapy 35 IJCP Volume 20 • Issue 3 • Autumn 2020

IACP Accreditations

Newly Accredited Supervisors

Alan Trimble Dublin 3 Gemma Kiernan Dublin 6W

Clodagh Dowley Co. Waterford Larry O’Reilly Co. Cork

Des McAnaney Co. Cork Maurette Fogarty Co. Cork

Accredited Supervisors - Dates for Your Diary!

Supervisor Forum Meetings 2020

Supervisors Forum: Zoom Event

Topic: Facilitating Case Conceptualisation & Treatment Planning in Supervision

Presenter: Gus Murray

Date: 10th Oct 2020

Time: 10:00 – 16:00 (including one hour lunch break)

CPD: 5

IACP Supervisors only

Deadline for bookings: 25th September 2020 Slides/Handouts will be made available before the event. The Zoom Link and Password for the event will also be sent in advance. NB: There will be no recording of this event.

Please note: CPD Certificates will be sent out to all participants after attendance at the Supervisor Forums.

36 Irish Association for Counselling and Psychotherapy Volume 20 • Issue 3 • Autumn 2020 IJCP

IACP Therapy Academy Portal (Full Details available at www.iacp.ie)

New CPD Offerings on the IACP Online CPD Portal

FREE CPD FOR SUPERVISOR MEMBERS CBT Supervision: Using Cognitive-Behavioural Case Formulation in the Supervisory Context CPD hours: 3 Presenter: Eoin Stephens, MA, MIACP, MACI.

This training describes an approach to supervising therapists who have a strong element of CBT in their work. The supervisory approach quite closely parallels the approach of CBT itself, in that it tends to be relatively structured, goal-focused, educative, skill-focused, and concerned about guiding both the client’s and the supervisee’s experiential learning between sessions. The workshop reviews the CBT approach, and then links it to supervision work, especially using the framework of Cognitive Behavioural Case Formulation.

FREE CPD FOR IACP MEMBERS CBT & Motivational Interviewing for Weight Management CPD HOURS: 3 Presenter: Susi Lodola MIACP

The aim of this course is to provide you with an outline how CBT and MI can be applied to help your clients with weight management. Over the last decade, the field of behaviour change has encouraged the integration of different forms of evidence-based treatments by identifying their general factors and shared elements and applying them across multiple behaviours. Obesity is a major health risk and underlying psychological factors, such as anxiety, stress, mood disorder and self-esteem can be the root cause of the failure to lose weight and keep it off. Psychological interventions are key to engage individuals in lifestyle modification and motivate them to achieve weight loss in sustainable and successful manner. Psychotherapies for obesity typically could help people achieve successful weight loss by reducing dysfunctional behaviours and restructuring cognitive processes. CBT has been recognised as well-established treatment for obesity and is considered to be the first-line treatment among psychological approaches.

Date for your Diary IACP 2020 AGM

IACP 2020 AGM will be held on Saturday 5th December in the Galway Bay Hotel, Salthill, Co Galway. Further information and booking details will be announced in the coming months.

Irish Association for Counselling and Psychotherapy

Irish Association for Counselling and Psychotherapy 37 Athlone – Galway

A Career in Counselling & Psychotherapy Diploma in Advanced Supervision 4 year BA (Hons) in Holistic Counselling & Psychotherapy, across Professions Level 8 QQI validated IACP Accredited/Recognised by Supervisors Association of Venues – Athlone and Galway, October 2020 Ireland. Co-facilitated by internationally recognised Supervision experts – Dr Geraldine Holton, Dr Bobby Moore and Robin Shohet Venue – Athlone, November 2020 Upgrade your Qualification Professional Diploma in Expressive Arts 1 year add-on BA (Hons) in – 60 CPD hours Holistic Counselling & Psychotherapy, This Diploma in Expressive Arts Therapy has been Level 8 QQI validated described as unique and pioneering in Ireland and Venues – Athlone, September 2020 is for professionals wishing to use these processes in their work CPD Online Courses Venue – Athlone, January 2021

Reflection and Retreat in Nature Professional Certificate in Personal Development Course Psychosynthesis – 30 CPD Hours Mindfulness and Mindful-Living Programme A body, mind and spirit approach to well-being. Certificate in Bereavement & Loss Venue – Athlone, January 2021

Grow By Giving Join our free ONLINE THERAPY SCHOOL & enjoy short therapy

Master Clas ses from home

www.HYP NOSISACADEMY.IE

or call Sus an on 086 343 2992

IACP accredited Fulfils IAHIP criteria for supervisor accreditation Super.Vision Training Multi professional training in Humanistic & Integrative Supervision

The course focuses on the skills, theory and practice and enables participants to supervise across professions. Training starts January 2021 – blended delivery F2f Ennis, Co.Clare Places limited, applications now being accepted. Details and application at www.supervisionconsult.com or Annie Sampson 087 2320525 [email protected]

38 The appearance of an advertisement in this publication does not necessarily indicate approval by the IACP for the product or service advertised. Blended Learning While Social Distancing Required

Progress your Career in Counselling and Psychotherapy

• MA in Pluralistic Counselling and Psychotherapy • MA in Integrative Child & Adolescent Psychotherapy • Level 9 QQI Certificate in Cognitive Behaviour Therapy • BA (Hons) in Integrative Counselling & Psychotherapy (RPL)

To learn more visit www.iicp.ie

66 Lower Leeson Street Dublin 2, Ireland Advertise with IJCP Tel: 01 6619231 2020 Advertising Rates www.gestalt.ie (Unchanged since 2005) email: [email protected] BLACK/WHITE Total DIPLOMA IN SUPERVISION: Full Page €738.00 A Gestalt Relational Model Half Page €442.80 Quarter Page €295.20 Part 1 Sept 21 – Dec 21 Part 2 starting Sept 22 Eighth Page €147.60 This Relational Gestalt Model of Supervision has been training Supervisors since 2005. It is an experiential course run over two years to IAHIP and IACP requirements. COLOUR Total The course is accredited by IACP. Outside Back Cover €1,107.00 Part 1 will begin Sept 21 and end in Dec 21 and Part 2 will start in Full Page €885.60 Sept 22. It is now open for enquiries. Half Page €590.40 The course is suitable for Counsellors and Psychotherapists, Quarter Page €442.80 Psychologists and Social Workers with an interest in working with the Supervision Relationship in a process way. Eighth Page €221.40 A prior knowledge of Gestalt is not a requirement FLYERS Total

Facilitators: Anne Burke, Eileen Noonan. (supplied by advertiser) €885.60

Max number of participants 12 All prices are inclusive of VAT @ 23% For details of courses including costs and dates: www.gestalt.ie / Tel: 01-661 9231 To advertise with IJCP contact: (Partners: Claire Counihan, Kay Ferriter and Bridann Reidy) [email protected] or 01 2303536

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l O I S N S d u n e t g i o e i o n n e N o y N S a D o S J The appearance of an advertisement in this publication does not necessarily indicate approval by the IACP for the product or serviceThe appearance of an advertisement the IACP by advertised. approval publication does not necessarily indicate in this © IACP, First Floor, Marina House, 11-13 Clarence Street, Dun Laoghaire, Co. Dublin. Phone: 01 2303536 Dun Laoghaire, 11-13 Clarence Street, Marina House, First Floor, © IACP,