Counselling within a hospice setting. A mixed-methods exploration of pre-loss and post-loss counselling in a palliative setting

Abstract

This research aimed to further knowledge of grief and bereavement by investigating whether pre-loss counselling could improve outcomes for individuals who have recently lost a close family member. The research examined how pre-loss counselling could help individuals cope with a loss and why this approach may reduce the client's time in post-loss counselling. Furthermore, to help inform current practice, the research explored the client's experiences of pre and post-loss counselling. The researcher utilised a mixed-methods approach utilising both interviews and surveys. Outcomes and accounts for two groups of 16 clients who underwent counselling at a Hospice in England were compared. The first group undertook pre-and post-loss counselling, whereas the second group undertook only post-loss counselling. A qualitative study, in which four clients from each group were interviewed, found that pre-loss counselling helped the participants relieve and process their negative emotions before and around their loved one's death. Moreover, the study highlighted that the pre and post-loss group was more concerned with finding a new purpose - and ultimately accepting their loss. The study also found that the pre and post-loss group was more advanced in coping strategies, possibly indicating why they required less post-loss counselling. In addition, the study found that participants who undertook pre-loss counselling benefited from their counselling in several ways, including helping them with their levels of emotional control, acceptance of their loss, helping with end-of-life care and their last moments with their loved ones. Some participants also felt their Counselling helped prepare them for life after the loss. A survey analysis of the 32 clients in the quantitative study showed that the pre and post-loss counselling group had a significantly lower overall vulnerability score. This second study further showed that the pre and post-loss group spent significantly fewer sessions in Counselling overall and significantly less time in post-loss counselling. A correlation analysis between the number of post-loss counselling sessions and the vulnerability scores was undertaken for each group. There was a stronger relationship between the number of post-loss sessions and a lower overall vulnerability score for the pre and post-loss counselling group. This stronger relationship may indicate that their post-loss counselling was more effective in reducing their vulnerability scores when combined with pre-loss counselling. Combining the two studies showed that pre-loss counselling improved clients' emotional stability and resilience, reduced their vulnerability, helped them accept their loss quicker, and built new meaning in their lives. In addition, both studies indicated that pre-loss counselling appeared to have reduced the participant's time in post-loss counselling. The research found substantial evidence demonstrating that participants had found their Counselling beneficial. However, the gains obtained from their Counselling differed depending on whether the participants had received pre and post-loss counselling or post-loss counselling only. This research provided new insights into pre-loss counselling, addressing a research gap in knowledge and producing a set of recommended aims and objectives for pre-loss counselling practice. Future directions for research are also provided.