Evaluating the efficacy of Existential and Cognitive theories to counsel clients grieving the loss of their loved ones

An Evaluation of the Efficacy of Existential and Cognitive Theories in Relation to counseling a Client grieving the Loss of a significant Person in his or her Life.

John O. Attram, PhD

ABSTRACT

The focus of this article is to describe the special

characteristics and challenges of bereaved persons with

difficulties in identifying and articulating their feelings. It

describes and evaluates the efficacy of treatment approaches

based on the existential and cognitive theories related to

providing relief to bereaved persons who grieve over the loss of

their loved ones.

Introduction

Bereavement has far-reaching implications, with

systemic variations of consequences, for the bereaved. Its impact

affects not only the physical and emotional well-being of the

bereaved, but also changes in networks, social status, and

financial situations (Niemeyer & Currier, 2008). Sometimes, the

grief is so intense that it takes a considerable length of time

for the bereaved to overcome the grief leading to symptoms that

have been shown to increase the person’s vulnerability to

functional impairment, substance abuse, and suicidal ideation

over the long term (Ott & Lueger, 2002). Helping professionals

meet with grieving clients at different stages of the mourning

process. Admittedly, they employ techniques based on theoretical

structures that engender relief, change, and growth in the

shortest possible time.

Worden (2002) differentiates between grief counseling

and therapy based on whether the goal of helping is to facilitate

uncomplicated grief or to resolve complicated mourning. However,

whether counseling or therapy, the professional’s responsibility

is to help individuals move from an impaired position to recovery

and change. According to Capuzzi and Gross (2003), recovery is

based on the attainment of several levels of goals that extend

from behavioral change to spiritual development. These goals are

dependent on the type of theoretical framework the professional

chooses to work with. Sometimes, the choice of a theory to help a

client return to functional capacity depends on the principles

that guide that approach.

Grief Counseling and Grief Therapy

Recent studies show that 10% to 15% of individuals

who grieve the loss of their loved ones do so for more than six

months or up to a year (Lichtenthal, Cruess, & Prigerson, 2004)

presenting with characteristics of major depressive episodes

including sleeping, eating and weight gain or loss. So,

professionals should examine the different features of the

bereaved including the extent of their losses, to be well-

informed about the type of interventions that will be beneficial

to the client. Accordingly, the presenting symptoms and problems

define the model that is likely to be more helpful for those to

whom it is offered.

Based on individual characteristics and coping skills,

people exhibit different grief responses, some of which extend

the timing and structure of the help provided by the

professional. Worden (2002) describes grief counseling as the

process of helping a bereaved person to successfully go through

the tasks of mourning within a short period of time. In grief

counseling, the client is helped to come to terms with the

reality of the loss and overcome the obstacles of readjusting to

life without the deceased loved one. Conversely, grief therapy

focuses on identifying and resolving the conflicts of separation

which prevent the individual from completing the tasks of

mourning. Its application is suitable in grief that is

complicated, prolonged, exaggerated, or delayed (Capuzzi& Gross,

2003). Furthermore, it is used when the bereaved presents with

some masked somatic or behavioral symptoms. The theoretical

aspects of grief therapy should, therefore, focus not only on

emotion regulation, but also on dealing with traumatic imagery

associated with the loss, countering fatalistic thinking and

hopelessness, and addressing practical readjustments in life to

promote adaptation (Currier, Holland, & Niemeyer, 2004). It

follows that, counseling on the other hand, is the approach to

use when helping a person who responds normally to the grief

process but needs to readjust to life after the loss of a loved

one. However, in either situation, the techniques used in the

grief process should be theoretically oriented and derived from

empirical knowledge, and not just based on intrinsic

descriptions.

Yet, as suggested by Worden (2002), realistically,

theory and practice are inseparable processes confronting

professionals who assist the bereaved. He suggests that any

method used to assist with the grief process should be based on a

solid theoretical understanding of human personality and

behavior. Similarly, Shapiro (2008) links recovery from grief to

the prospects of restoring social and occupational functionality

based on individual, relational, and cultural responses. This

view is confirmed in the bereavement literature that suggest that

the age of the bereaved, relationship to the deceased, and other

situational factors as precipitants to complicated grief

(Sandler, 2001; Bonano, 2004; Kazak & Noll, 2004). It follows

that successful grief therapy should be ethically oriented, based

on individual and family strengths. Treatment should be centered

on the client in collaboration with the professional.

Existential psychotherapy Theory

When applied in grief therapy, existential theory seeks

to help respect the pain that takes place at various levels of

human experience. The client is made to understand that death,

freedom, isolation, and meaninglessness are viewed as the

ultimate relevant human concerns (Yalom, 1981). Hence, the way in

which each of them is confronted constitutes the content of the

individual’s inner conflict.

Existentialists view death as the ultimate and obvious

human concern. It plays a prominent part in the internal

experience of human beings. To cope with the fear of death,

humans build around themselves walls of denial-based defenses.

Psychopathology occurs when people are not able to transcend

death awareness (Corsini & Wedding, 2004). Existentialist

techniques seek to heal the attendant symptoms and maladaptive

character structure through letting go of the unhealthy parts of

self, relationships, or principles.

The existential view of freedom is that human beings are

responsible for all their actions. Humans are the creators of

their actions, choices, world, and life design, therefore, they

are also responsible for the void and nothingness that exists

beneath them (Cappuzzi & Gross, 2003). The internal dynamic

conflict that emanates from this view is the human need and wish

for ground and structure. When an individual experiences a wish,

they are faced with the decision of satisfying it, which often

results in a decisional panic.

Isolation is a separation from oneself as much as from

others. Farber (2009) demonstrated the dilemma of existential

isolation in a study of HIV-related bereavement psychotherapy,

and described the feelings of loneliness experienced by clients.

According to Yalom (1981), existential isolation derives from a

conflict between the reality of fundamental aloneness and the

human quest for social connection and belonging to a larger

whole. There is a clear distinction between existential isolation

on one hand, and interpersonal isolation and intrapersonal

isolation the other. Existential isolation refers to the

inescapable fact that no matter how close we may get to another

person, there is an ultimate separateness that we cannot

eliminate.

The fundamental loneliness of the human condition is

that humans enter and leave the world alone despite their fervent

wish to merge with others or be protected by them. Thus, Hammer

(1972) believes that loneliness is the central concern of

psychotherapy. At the root of loneliness is the fear that unless

the self is recognized and affirmed by a valuable other, it will

cease to exist. He argues that the longing for another is a

desire to affirm one's own existence through the recognition of

another. However, the attainment of another's love is only an

illusion of preservation of the self. In fact, it is only a way

to forget the ultimate loneliness by distraction, by using a

person in much the same way that some use aimless activity as a

distraction from boredom.

The existential therapist seeks to help clients

understand that loneliness and emptiness are inescapable parts of

the human condition and that one can learn to live with them. In

therapy, the client learns to address existential isolation

directly (Corsini & Wedding, 2004). However, this therapeutic

task becomes difficult for some clients because they lack

sufficient experiences of closeness and relational interactions.

In his inquiry into oral communication problems among

adolescents, Yalom (1981) asserted that individuals from loving

and supportive families easily disengage from their families, and

are able to tolerate the separation from their families in

adulthood. Conversely, those from conflicted and dysfunctional

families find it difficult to break away from their families

because they lack the skills to separate and, therefore, stick to

the family for support against isolation. It follows, therefore,

that psychopathology sets in when the bereaved faces a separation

conflict leading to an inability to complete some or most of the

tasks of mourning. Sometimes too, the demonstration of pathology

may be due to relational factors. An ambivalent relationship with

a deceased loved one may lead to complicated grief because the

surviving member of the relationship may be ill-equipped to

handle life without the dead loved partner.

According to Fry (2001), findings from a

phenomenological study of the efficacy of existential therapy

brought out themes of loss of purpose for living and intensity of

existential confusion and incoherence immediately after the loss

of significant loved ones. Hence, existential therapy seeks to

address situations of loss, hopelessness, and confusion

associated with the death of a loved one.

Spirituality is another aspect of the human

experience used by existential therapists to bring change to

their clients (Bartz, 2009). One of the roots of existential

thinking is the philosophy of life. Hence, he makes a point that

the first way in which spirituality enlarges the role of

existential grief therapy is by adding the task of facilitating

confrontation with existential fear. Human beings become afraid

when they do not understand what confronts them. They therefore,

look for answers from a higher being.

The spiritual perspective is that one of the main

purposes of life is to develop spiritually, and that growth only

comes as humans allow themselves to experience fear and other

forms of suffering (Slife & Reiber, 2001. Clinically, the

spiritual aspect of the existential model can be broadly applied,

but it is not a universal theory. It should be seen as temporal

and changeable that should be adapted to other theories in the

best interest of clients.

The clinical implications that may be deduced from

spirituality in the existential approach to grief therapy is that

it allows clients to be fully aware of the underlying dynamics of

their predicaments and become enabled to confront the fear of

avoiding their ultimate concerns. However, it must also be stated

that some feelings of fear may not be attributed to the

confrontation of ultimate concerns, but may be warnings that need

attention.

Existential counseling meets the client where he or

she is, and is respectful of each client's uniqueness,

individuality, and culture (Weinrach, 1991). It provides a

philosophical framework for the therapeutic encounter without the

encumbrances of techniques and agendas. Existentialism offers the

client far more than symptom relief. It brings the client to the

realization of the fundamental essences of life which Yalom

(1980) sums up as the realities of the human condition: death,

freedom and responsibility, meaninglessness and loneliness. A

combination of existential therapy techniques and grief practices

leads to loss resolution in this inner spiritual journey

(Spillers, 2007). Though, there are external resources like

family, friends, religion, or spirituality to provide support in

this journey, how individuals face these challenges is their own

responsibility.

Cognitive Theory

Cognitive therapy is effectively applied in many

psychotherapy situations including grief therapy. It enables the

patient to correct false self-beliefs that can lead to negative

moods and behaviors. According to Balk (2008) cognitive therapy

is based on the assumption that a thought precedes a mood;

therefore, a person needs to learn to substitute healthy thoughts

for negative thoughts to improve their mood, self-concept, and

physical well-being.

Cognitive theory of personality maintains that people’s

attitude to life events, and this case, grief, is through a

combination of cognitive, affective, motivational, and behavioral

responses (Capuzzi & Gross, 2003). Chambless and Ollendick (2001)

confirm the cognitive belief that people’s excessive affect and

dysfunctional behavior are the result of the excessive and

inappropriate ways they interpret their life experiences. Thus, a

person who has lost a significant person in their life will

perceive the situation as requiring a response. Suddenly, a

whole set of cognitive, emotional, motivational, and behavioral

schemas come into play in their mind. In this way, all aspects of

the person’s functioning act simultaneously in consonance with

their thoughts.

Similarly, Corsini and Wedding (2004) describe

individuals as having a set of idiosyncratic vulnerabilities and

sensitivities that expose them to psychological distress. These

vulnerabilities are related to personality structure which in

turn is shaped by temperament and cognitive schemas. Likewise,

Beck, Freeman, & Davis (2003) describe cognitive schemas as

structures that contain the individual’s fundamental beliefs and

assumptions. He adds that they are developed early in life from

personal experience and with significant others, and are further

reinforced by learning experiences which in turn influence the

formation of beliefs, values, and attitudes. Therefore, an

individual’s personality attributes can be described as having

been developed in response to their environment and interpersonal

activities.

An important assumption in the cognitive theory is that

vulnerable individuals develop a negative or depressive schema

for themselves that, although dormant for a certain period in

life, becomes evoked by salient negative life circumstances. Once

activated, these schemas influence the content of cognition that

becomes available and processed (e.g., negative automatic

thoughts and dysfunctional attitudes (Dozois, Bieling, Patelis-

Siotis, Hoar, Chudzik, McCabe, & Westra, 2000). Thus,

conceptually, the schema construct is believed to be stable, but

impenetrable, whereas automatic thoughts and dysfunctional

attitudes are comparatively more transient and dependent on the

person’s state of mind.

In their study of self schema structure in cognitive

therapy, Dozois and others (2000) describe cognitive therapy as

highly effective for treating the acute phase of a depressive

episode and that it also reduces the risk of relapse and

recurrence. The study demonstrated that negative automatic

thoughts and dysfunctional attitudes declined and positive

automatic thoughts increased, with no differences between them.

These results have clinical implications for understanding the

mechanisms of change in therapy for individuals who experience

depressive symptoms as a result of schema changes (Corsini &

Wedding, 2004). The changes in a grieving person’s schema may

include depression, anxiety disorders, mania, panic and paranoid

states, phobias, and suicide ideations. Loss actualization and

cognitive restructuring are some of the cognitive procedures used

to help individuals having difficulty in dealing with grief.

Depressed grieving persons have negative view of

self, the world and the future. They see themselves as deserted,

inadequate and worthless (Capuzzi & Gross, 2003). Their

pessimistic view of the world makes them think that their current

feelings of loss will not go away. These feelings sometimes lead

to suicidal ideation. The features involved here are based on a

high degree of hopelessness.

A person grieving the loss of a loved one to death

feels abandoned and detached from a protector. In these modes,

the individual presents with vulnerable emotions, including

sadness and fear, which go along with abuse and abandonment

(Young, 2005). They also block out their needs and feelings and

keep an emotional distance from other people to protect

themselves from harm.

Cognitive treatment in difficult situations, such as

post traumatic stress disorder, borderline personality disorder,

or depression, involves 9 steps which end with a final

termination of the relationship with the dead person. As

described by Worden (2002), a typical treatment plan will have as

its focus to resolve the conflicts of separation and to

facilitate the completion of the grief tasks. The goal of the

plan is to help the client to self-manage their affairs through

homework, hypothesis testing, exposure, and decision making.

Cognitive therapy begins with a building of a

collaborative relationship between client and therapist which

allows the therapist to assess the sources of the client’s

distress and dysfunction (Young, 2005). The developed

therapeutic bond helps in clarifying the goals of therapy. Since

the bereaved may have been avoiding their thoughts and feelings

regarding their loss, it becomes imperative for the cognitive

therapist to help the client to face them, which in turn, will

help in the resolution of those conflicts. When the client’s

dysfunctional thoughts of all-or-nothing and catastrophizing

diminishes, therapy moves on to teach social and communication

skills to engender change.

Evaluation of the efficacy of Existential Theory in Grief Therapy

It is always easier to measure the outcome of psychotherapy

when the approach used is more specific and focused on the goals

of treatment. According to Corsini and Gross (2004), existential

therapy views the client as a real, existing, immediate entity

and not as a compound of drives, or prototypes. Consequently, it

agrees with the innate presence of natural drives and history in

people, but these only come into existential therapy as parts of

a struggling human being in conflict with hopes, fears, and

relationships. It follows that the existential belief is that

each individual has normal anxieties and vulnerabilities and that

only the neurotic forms need to be changed in therapy.

The existential framework is based on the assumption that

human concerns such as death, isolation, and meaninglessness are

existential facts of life and that the client’s confrontation

with each one constitutes the content of their inner conflict

(Yalom, 1980). By confronting these constituents, the client is

able to achieve psychological well-being. However, DeRoon-Cassini

et al., (2009) made an inquiry into the psychological well-being

of individuals after spinal cord injury in relation to their

perception of loss and meaning making. They demonstrated that the

generation of meaning and purpose in life adds significantly to

the explained variance in psychological well-being. It can be

deduced from these two positions that what is more important is

the extent to which someone perceives the amount of physical

functioning that has been lost; an increase in perceived loss of

physical functioning relates to less well-being. The implications

of this study leads to the position of other studies that suggest

that existential therapy is not a comprehensive psychotherapeutic

method, but a frame of reference (Lucas, 2007). It is a paradigm

by which the therapist views the client’s suffering in a

particular manner. This does not make existential therapy less

effective but a demonstration of the difference between evidence

of efficacy and effectiveness.

An elemental tenet of existential psychology is that self

and world are fundamentally intertwined (Spillers, 2007).

Accordingly, the life of the individual is understood

holistically in the context of three dimensions of existence; the

natural, relational, and personal. This framework ties in with

HIV-related grief in the context of multiple and mutually

interacting physical, psychosocial, and psychological factors in

the life of the individual (Roy, 2008; Arehart-Treichel, 2001).

The generation of anxiety as a result of profound sense of threat

to individual existence due to grief is countered by existential

procedures. Accordingly, the existential focus is to help one to

live as fully as possible by overcoming resistances to

encountering their existential conflicts.

As similarly described by Spillers (2007), existential

theory is one medium through which people come to a realization

of their existence. Existential ideas, of death, freedom and

responsibility, loneliness, and meaninglessness, may be used to

complement other treatment models of treatment in order to bring

resolution and change to grief responses. Grief is a normal human

response to loss, therefore a combination of elements of

existential thought with a model of grieving will lend some

alternative insights into clients’ emotional and spiritual

experiences.

It is not seen as being superior to other models,

neither is it exclusive of them, but borrowed from various

disciplines; however, existentialism may illuminate a client’s

potential spiritual journey in ways not accorded by those models

(Spillers, 2007). Existential thought and grief theory may

therefore be interwoven with additional models to illuminate

other facets of clients’ spiritual journeys and growth.

The developmental perspective of grief counseling views

symptoms as life transitions and opportunities for growth.

Shapiro (2008) distinguishes existential theory from other

approaches, and views grief recovery as a shared developmental

transition. She cautions that resolution is not finally reached

when a client’s symptoms are reduced or their problem is solved,

but added that the disturbances created by symptoms and problems

will diminish when counseling is successful.

Ginter’s (1989) assertion that the ultimate goal of

mental health counseling is not problem-solving but a

reintroduction of developmental growth of the individual should

be seen as more important and genuinely therapeutic. Therefore,

existential responses to a client’s conflict with death, freedom,

loss, and meaninglessness may not be the resolution of their

fears. On the contrary, it is a gradual reintroduction of

developmental skills for the client to learn how to be alone in

the world and the meaning they attach to being responsible for

their own life, should be the goal of therapy.

According to deRoon-Cassini and others (2009),

evaluating the individual’s perception and understanding of loss

of functioning is imperative, as greater loss denotes more

resources to regain, which can be overwhelming and increase

stress. To aid in the grieving process, intervention at the

existential level that focuses on reshaping a sense of meaning

and purpose in life would seem to clearly increase psychological

well-being.

Existential therapy’s strength lies in its assumption

that psychopathology results from the client’s failure to

confront and integrate their inner conflicts and impulses

(Rogers, 2001). Specifically, the existentialist views neurotic

or maladaptive behavior as connected to avoidance. As clients

deny natural urges and avoid ultimate concerns such as death,

responsibility, isolation, or meaning of life, they progressively

or all of a sudden develop psychological, emotional, or

behavioral symptoms.

The existential cure generally involves facing oneself,

facing life, and embracing the reality of death, freedom,

isolation, and meaninglessness. Life does not come easy with this

approach. However, as Rogers (2001) points out, clients who face

ultimate concerns with an integrated sense of self experience

normal anxiety and guilt rather than neurotic anxiety and guilt.

These existentialist principles are similar to those of

the Gestalt theory which defines psychopathology in terms of the

client and the environment (Capuzzi & Gross, 2003). Gestalt

theory states that when clients lose contact with the

environment, they are likely to experience stagnation or an

inability to grow, adapt, and cope. In the Gestalt framework,

symptoms come about as a result of dysregulation in the confines

of self and environment. Similarly, according to existential

thought, psychological health is characterized by a healthy

boundary between self and environment.

The efficacy of the existential theory in grief therapy

is also based on another central philosophy of existentialism,

which is self-awareness (de Roon Cassini et al., 2009). With this

philosophy in mind, the existentialist’s goal in therapy is to

help the client to get in touch with their authentic self. The

objective of such a goal will be to facilitate the client’s self-

awareness including awareness of death, freedom, isolation, and

the meaning of life.

The central principle of existentialism is its

preoccupation with polarities with respect to diversity (Torres-

Rivera et al., 2001). In spite of its ethnocultural sensitivity,

feminists and multiculturalists view existential therapy as

promoted by wealthy dead European men (Enns, 1977). Regardless of

this criticism, existentialists postulate the importance of

individual sanctity and individuality of the self. The

existential focus on the individual and the content of their

conflicts creates an efficacious way of alleviating personal

issues such as those incurred when one is confronted with

difficulty in dealing with grief.

Evaluation of the efficacy of Cognitive Theory in Grief Therapy

The psychotherapy outcome literature provides empirically

based evidence of the efficacy of cognitive theory in grief

therapy (Beutler, 2000; Chambless & Ollendick, 2001; Rupke et

al., 2006). Clients who view their problems in terms of symptoms

have been shown to respond well to cognitive therapy, because

cognitions play an important role in the development and

maintenance of psychological problems. Barber and DeRubeis (2001)

studied depressive individuals undergoing cognitive therapy.

After 14 weeks of therapy, the clients were able to use

compensatory skills and displayed optimism about the future. The

study also showed that patients’ levels of compensatory skills

improved significantly.

Individuals having difficulty in adjusting to life after

the loss of a loved one need help to deal with explicit and

latent affect. Young (2005) validated therapies that have a

particularly strong cognitive emphasis in grief therapy. These

include cognitive therapy for depression, and in addition to

behavioral therapy, for panic disorder and generalized anxiety

disorder. The symptoms are associated with individuals who are

undergoing stress and anxiety due to grief and loss. However,

other studies demonstrate that cognitive therapy on its own is

not adequate to treat the symptoms stated above.

According to de Jonghe et al., (2004), the relative

efficacy of therapy in the treatment of depression is debatable.

A set of depressive patients were treated with cognitive and

psychodynamic approaches and compared with another set that were

treated with antidepressants. Yet, another set were treated with

a combination of antidepressants and psychotherapy. The results

showed that combined therapy was more efficacious than

psychotherapy in the treatment of depression. In all, cognitive

therapy has been effectively used to manage acute episodes of

major depression, and also prevent relapse.

Jordan and Neimeyer (2003) reviewed the types of

interventions for mourners and concluded that since grief is

unique to each individual, a combination of different techniques

helps to assuage the mental difficulties bereaved persons go

through. Again, some interventions are customized for particular

needs, as in the case of the death of a child, or homicide

survivors (Rynearson, 2001). However, a mother who has lost a

child or grieving a family member who committed suicide goes

through cognitive impairment leading to behavioral problems which

need to be repaired.

In grief therapy, the client’s behavior becomes the

physical evidence of psychological problem, therefore any

treatment approach should be an amalgamation of cognitive and

behavioral response (Ehlers & Clark, 2000).The cognitive

therapeutic goal of helping the client to achieve emotional

equilibrium after a loss begins with the therapist demonstrating

to the client that the latter exhibits irrational thought content

or behaving in a maladaptive way. This leads to teaching the

client new and better thought procedures by means of a technique

known as cognitive restructuring.

Riley et al., (2007) suggest the use of both

theoretical and empirical procedures that ensure the development

of effective interventions in grief therapy. They contend that

cognitive techniques of skill-building, including conflict

resolution, listening, assertiveness, problem-solving and

communication are efficacious in helping individuals undergoing

grief-based psychological problems to return to functionality.

During treatment, the cognitive therapist engages the client in

activities that ensure growth in self and in interpersonal

relationships to bring change and relief.

As stated earlier, individuals dealing with grief

demonstrate unhealthy psychological responses leading to anxiety,

anger, depression, panic attacks, suicide ideations, and post-

traumatic stress disorders. Outcome studies have shown the

efficacy of cognitive therapy in these situations. In controlled

studies by Dozois et al., (2009), it was clear that cognitive

therapy was efficacious in the treatment of panic attacks.

Similarly, it is effective in the treatment of post-traumatic

stress disorder (Ehlers & Clark, 2000) and generalized anxiety

disorder (Brown, Perlman, & Goodman, 2004).

Additionally, cognitive therapy appears to lead to lower

relapse than other treatments for anxiety and depression (Brown,

Perlman & Goodman, 2004; Sharkin & Knox, 2003) due to its

emphasis on the role of information processing in human responses

and adaptation. Because the loss of a loved one instantly changes

the survivor's life, any subsequent event may be absorbed through

the bereavement framework. The initial challenge is making the

loved-one schema less salient. Until this schema loses prominence

and energy, the mourner cannot attend to other information.

Cognitive therapy helps the client to come to an understanding

that their functioning depends on the information they send to

their minds and the capabilities of their minds to respond to

such information.

Cognitive therapy has been criticized in several ways.

The client needs to believe in therapy to experience change.

Since cognitive techniques hinge on the use of homework

assignments, a difficult assignment may lead the client to

experience a higher stress level. To prevent these situations,

Rupke and others (2006) suggest that there should be consensus on

the aims and goals of therapy, and the therapist must provide the

client with feedback during sessions to clarify any

misunderstanding and increase collaborations.

Cognitive therapy derives its strength from the

empirical support for its theoretical framework and the large

number of outcome studies with clinical population (Capuzzi &

Gross, 2003). In addition to its focus on understanding the

client’s problems and application of appropriate interventions,

cognitive therapy also attends to unspecified characteristics of

the therapist ( Corsini & Wedding, 2004) leading to the cognitive

values of empathy, acceptance, and unconditional positive regard

which creates a valid therapeutic environment that accelerates

change.

Conclusion

There are several fundamental mechanisms that cut

across all forms of treatments. Three of these mechanisms are:

(1) a comprehensible theoretical framework, (2) the client’s

emotional engagement in the problem in treatment, and (3) reality

testing in that situation (Servaty-Seib, 2004). The choice of one

theory or the other is based on the specificity of the case and a

search for an efficacious and empirically-based approach to help

the client. The underlying principles of existential theory and

cognitive theory both serve as guidance for the therapist to

bring relief, change and growth to the bereaved client.

Moreover, as described by Norcross, Hedges, and Prochaska (2002),

many of the principles from these theories can be combined and

integrated in their use. Even though mourning may be based on the

individual peculiarity of the client, these theories direct both

client and therapist to a mourning process that must be seen as

characterized by acceptance, balance, and flexibility.

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