Compare and Contrast the Cognitive Behavioural and Psychodynamic Approaches to Counselling Focusing Particularly on Loss and Bereavement

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Compare and contrast the cognitive behavioural and psychodynamic approaches to counselling focusing particularly on loss and bereavement

Coping with the death of a loved one often means that the bereaved must develop a new way of viewing themselves and the world around them without the presence or influence of the deceased. In general, reactions to the loss of a loved one are considered intense in the initial period following the death, but on average, these feelings lessen over time (Parkes, 1975; Rando, 1993; Sanders, 1989, 1993, cited in Malkinson, 2001). Some bereaved individuals can successfully cope with this transitional phase and are capable of returning to “an adaptive level of functioning” within the time frames expected (Marwit & Matthews, 2004) without experiencing severe impairments. However, some grievers can experience severe affects to their physical and psychological well-being (Gallagher-Thompson et al., 1993; Ott, 2003; Stroebe & Stroebe, 1987, cited in Marwit, et al, 2004); cases in which the bereaved is demonstrating prolonged irrational beliefs and/or behaviours about the loss can be an indication of an emotional disturbance (e.g. complicated grief). Complicated grief (CG) can be defined as “the intensification of grief that does not lead to assimilation of the loss but instead to repetitive stereotypic behavior as well as impaired functioning” (Malkinson & Witztum, in press, cited in Malkinson, 2001, p. 672).

The discourse of this paper will compare and contrast psychodynamic and cognitive-behavioral theories with examples of models used to facilitate grief work in situations of complicated grief as well as a brief explanation of what is considered grief resolution. Let us begin with a brief explanation of the core principles of each approach.

Psychodynamic counseling is concerned with the role of the unconscious, childhood experiences and how they can ultimately effect our mental processes which in turn manifest in our actions. According to this approach in order to deal with conflicts certain defensive actions or mechanisms instinctively come to our rescue whenever we feel vulnerable or as if our view of reality is being challenged. For example in bereavement cases, clients will often use denial as a defense mechanism and coping strategy in order to avoid the intense pain that comes with acceptance of loss. However effective this may be for short-term relief, in the long run, the client runs the risk of developing symptoms of complicated grief (Hough, 2010).

Contrariwise, cognitive-behavioral approaches place almost no emphasis on the past and childhood events, unless it directly relates to difficulties of the present day, in such cases it acknowledges but does not focus on this factor. Rather it concentrates on present day thinking/behavioral patterns exhibited by the client, ways to recondition the client’s cognitive processes and how to eliminate unwanted or destructive cognitions and behavior. Additionally, (and specific to aspects of behavior) this approach adheres to empirically sound principles and procedures that have been tested for their effectiveness and reliability (Hough, 2010), whereas the psychodynamic approach is theory based. The rationale behind CBT being, since negative patterns of thinking and behaving are learned they can be unlearned. We now examine established beliefs about grief and grief resolution.

Grief has traditionally been seen as a healthy process aimed at decathexis, abandoning or letting go of commitment to one’s relationship to the deceased (Freud, 1917/1957, cited in Malkinson, 2001) as well as the ability to form new relationships (Malkinson, 2001). During most of the 20th century, leaders in bereavement research followed Freud’s (1917/1957, cited in Marwit, et al., 2004) theoretical model of decathecating grief in which he believed that the bereaved invested a great deal of mental energy into maintaining the attachment to the deceased and in order...
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