Mental Health vs EMS - Part Three

The comments outlined above notwithstanding, there is always a need to work within a conceptual framework to ‘enable’ the parents. 

There are any number of approaches available and you should pick and choose one that makes sense to you and the environment in which you work.

I favour the somewhat basic ‘Client centred’ approach, which aims primarily “toward fostering personality growth by helping individuals gain insight into and acceptance of their feelings, values, and behaviour.” Encyclopedia Britannica.

It is a simple approach and not without its detractors.

There are also various sub-disciplines and I am inclined towards what might be called ‘principled Nondirectiveness’. 

Here the “therapist’s actions are derived from the fundamental idea of respect for persons. 

The therapist does not attempt or intend to make anything happen — growth, insight, self-acceptance — in the client, but rather provides the therapeutic conditions in the belief that they are expressions of respect and with the hope that the client will make use of them.” (Brodley, 1986; Grant, 1986).

This approach does not really take into account the deep unconscious motivators of our more complex response to life but which you can-, and must-, assume are always present.

Rather, it is used as a tool to view the patient’s response to their grief work. 

It allows the counsellor to ‘treat’ the patient, by acknowledging that work needs to be done. And that the bulk of that work is the expression of their anguish and pain.

This theory believes that there is a fundamental split between “the need to be liked and have your actions approved of” and “the need for self expression”. 

Although it is simple, it is an uncomplicated approach to use in examining the expression of-, and adaption to-, the required grief work.

“The function of the therapist then is to extend consistent, warm, ‘unconditional positive regard’ toward ‘clients’; and, by reflecting the clients’ own verbalized concerns, to enable them to see themselves more clearly and react more openly with the therapist and others.

Pace, direction, and termination of therapy are controlled by the client; the therapist acts as a facilitator.”  Encyclopedia Britannica.

So we hope that the client will grow towards himself, -towards his own authentic self-, what ever that may be, and not towards some psychological theory.

In a sense, we are all too complex to have our behaviour and emotions explained away or understood, by only one set of belief systems.

Nevertheless, and quite self-evidently there are large societal and religious groupings that do “grow towards themselves” on strictly taught ‘one-party’ lines. 

Events such as mass suicides of doomsday cults bear stark witness to the dysfunctional growth of the individual, who chooses for himself to explain his actions and understand his world, through only one set of belief systems.

And this is of course what lies at the bottom of grief work.

As a scientifically trained Nurse or Doctor or paramedic you will have been taught that there is no single explanation for human behaviour. 

Unfortunately, the patients in the EMS milieu haven’t been taught the same thing.

The point at which bereavement occurs is not the time to discuss this with the family. They may choose to respond to the bereavement, from what they think is the single governing principle of their life, such as religion. 

Whilst it is manifestly not true, it is incumbent that you listen to them and are guided by them.

The more complex integration required for them to reach a state where they can emotionally relocate their child, can be done in the months and years to follow.

Sister Francis Dominica says, “Grief is like a jigsaw puzzle without a picture”. She firmly believes that the “parents are the experts, and that the single most important function of the grief counsellor is simply to bear witness”

She says that “what has become obvious is the need for the nurse ‘simply’ to act as gatekeeper. Firstly, to “be there’ to help the child through the gate in an as appropriate manner as possible. Secondly, is the need to remember that the parents were and still are, parents; that they had a child and were a family.”  (Paper presented at third Int’l Conference, Ontario)

What is required, particularly in the death of a child, is for the parent to be brought ‘back to himself’, to a point where he may experience his own feelings and not those of a superimposed ‘society’ or religion or culture of the medical team.

Of course, on occasion, the patient may be so grounded in his religion so as to be unable to truly express his grief and the counsellor has to be vigilant to what the patient is “saying” and what he is “expressing” which are often two completely different things.

The issue as always is not that I want to interfere in the parent’s real life; if they are profoundly religious and daily practice their religion, then that is probably the matrix they will use to help them through the process.

The problem is that the death of a child is often so shocking that they are cut off from their spiritual resources.

And in what may be loosely described as ‘western, Christian-oriented, pleasure –seeking’ society at least, and in a new digital world, the old diktats of formalised and frequently prescriptive religion, often have no lasting relevance or absolute-conviction-status. 

I use this model in conjunction with the various schemas of ‘transitions of mourning’ models discussed elsewhere in this text; as well as the various definitions of grief and how children express their grief.

And do not think for a single solitary minute that children do not express grief or that they do not transition through the bereavement process.

They will express their grief in different ways to adults, and in different ways to other children, largely dependent on their (cognitive) age at the time of the death; in subtle ways; through drawing and music; by re-creating their dead sibling as an imaginary friend.

They may, -or may not-, ask many questions; and the scope and depth of the questions may change, as the child grows older.

So as always, it’s not about trying to impose any particular schema on the parents; it’s about making sure that they get some help, of some sort for some time to come.