Cognitive Biblical
Therapy Coursework
Counseling Through God’s
Transformative Word
Course 4, Chapter 24
Welcome to Section 6: Special Counseling Issues
Chapter 24 Processing Grief/Long Illness
Grieving and serious illness have many of the same dysfunctional patterns of low quality of life, lack of hope, stressed relationships, and poor outlook for the future. Dr. Wilkinson breaks down underlying issues in the presenting problem of their loss, realities in their life and inability to control their present world and hope.
Essay Questions: Answering the section questions (red buttons) is a great way to prepare for the end of the Chapter Quiz. Chapter 24 questions require you to analyze the case study and apply both present and previous course understanding, while using common sense. The section questions will provide Dr. Wilkinson’s feedback to your answers.
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Chapter 24
Processing Grief, Coping with a Long Illness
Struggles with Grief and Loss
Our next topic for our discussion is grieving over the loss of a loved one, and over loss in general, including coping with a long illness. We will be using Case Study 24 of a couple and in their case, they lost a child. The following section will be Case Study 25 of a woman coping with a long illness. You will use both the man and woman’s composite scores from the Analysis Questionnaire and the Symptoms and Treatment Text beginning on Loss. Notice the symptoms of the dysfunction will be things such as lethargy, which means not getting up, not dressing or leaving the house. A loss of weight through loss of appetite and just no desire to eat, poor performance in general, at work, at home, and within relationships. Poor performance at work by getting there late, and setting and staring into space. Other caring activities fall off such as letting the house be a mess, not washing the car and getting groceries. Maybe fall comes and the man doesn't clean up the yard or the gutters, has emotional outbursts, and fits of yelling, crying. Why me? This is terrible. I can't believe this. How can this be happening?
Under symptoms of dysfunction, says an overly long time of grieving. Grieving can't be boxed and put in a category that says, if you lose your spouse, you grieve for two months. If you lose your child, you grieve for three months. If you lose your job, you grieve for two weeks. There isn't any preset length of time, but an overly long time of grieving will be when the thing drags on and on and on, and so the person literally ceases to live without making any progress toward healing. (Research Prolonged Grief Disorder in DSM-V-TR.) They don't deal with things, they don't go to see friends, they become physically sick. It's when they have sort of checked out from life. When they have ceased to move forward, then you can begin to identify that as an overly long amount of time spent in grieving. Also, an alienation from God since nothing changes in the way they feel or their loved one is not coming back. Also, a sense of anger or confusion toward God. There can be a sense that God doesn't care and He's abandoned me. When you see somebody, especially, who has had a good relationship with God, and talk that way, and they don't come out of it. If they get bitter and angry, there's a difficulty that needs treatment. Treatment says, explain the process of grieving to the individual. This is a God-given process of emotional and cognitive healing. First is denial that something has happened, that the husband or wife has died, or the child is gone or the job is gone. So, grieving can be over many different losses including people. It's grieving over anything that is lost, that's changed, that's threatening, and even yearning for the past or the good old days. This unwillingness to go on stems from grieving over anything. After denial can come intense sadness and/or anger. Why did this happen? The fellow with the loss of employment had all those years that that company had devoted himself to them, knew the people, and now all of a sudden, that whole security net is gone, and he has an extreme sense of grief and loss. Its intensity caused him to have lethargic, intrusive sad feelings of loss that interferes with one’s thinking, such as a struggle with interviews for a new job, and to be very skeptical.
There is a need to explain these emotional reactions of denial, intense sadness, anger and then acceptance, in order to get back into the process of starting life again. Learning to live with the negative feelings may just be the goal for now, in the midst of daily activities. It may be going to job interviews, back to college, or reengaging in living in the small things. In Case Study 24, the loss of a child, it is important to explain the reality of eternal life through Christ that all individuals have the right to. This is true of those who do not reach the age of accountability like a child who is received into heaven automatically. In this case, the child was about six months old into the pregnancy, and the woman ended up losing the child in a miscarriage. You will need to assess the client’s level of knowledge by listening to how they're dealing with the situation. If they don't have a sense of the eternal life of the child, or if they are grieving the loss of a loved one, then you need to make eternal life very clear to them. Once they are able to process that truth at some point, they will get a sense of security and peace with the whole situation.
Also, treatment says, analyze the client's personality type, coping mechanisms and his or her concept of God through the questionnaire that is specific for their issue of loss. Now, the reason I worded it that way was you have to both look at the grieving person, as well as their relationship to the deceased person if that is an adult. The questionnaire results will show you their concepts and what the deceased person was like. By knowing this you will understand how they are processing things in order to help them see how the relationship to the deceased was like. If you get someone who has an unsaved friend or spouse who dies, they will struggle processing that grief. They want to know where they are, in heaven or hell? You can't directly answer that, because you don't know the person. You don't have the facts, and you are not God. But if you help them understand themselves and what they are thinking and feeling, that will help them come to accept that God can be trusted to do the very best thing.
Looking at this case study of a married couple exposed two or three major issues. The first issue was that they experienced marital difficulty for quite some time, and conceiving a child put a strain on the relationship, which was the last straw. They'd been married about five years, and when she became pregnant, the man lost his whole sense of control, emotions, and hope. He made a decision to move out, and was getting ready to do that, when she had the miscarriage. Now, some of their past history was that she was a” talk to me and let's deal with things” person. On the other hand, he was more of a “passive, laid back” type person. When she had become pregnant, it added to all of the situations in his life that he didn't like. In the past years she had been involved in adultery. Because of his tendency not to deal with things, he would say, “Oh, it's fine, it's okay. I know you love me. It's just something that happened. It's all right, it's over, I'm fine.” Inside, he was miserable and upset and just very angry. And she didn't know it, because he wouldn't talk.
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What are the common emotional and physical symptoms of dysfunction when someone struggles in their grieving process?
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Dr. Dan's Answer:
Grief does not have a strict timeline or a structure in which one grieves. A long grieving process is marked by a lethargic state, inability to think clearly, loss of appetite and weight, poor performance at work or home, neglected responsibilities, frequent emotional outbursts, and physical illness.
The Underlying Problem
The first thing that they grieved over was the loss of the child, because they had wanted a child for many years. But then the second thing that they had to deal with was his leaving. They had to face jointly the potential loss of their marriage since death of a young child, or a miscarriage can often lead to separation and divorce. In his mind, he was glad, in a sense, that they lost the child, because he had a deep sense of being trapped and hopeless when he realized she was pregnant. That is what really motivated him to move out and to leave the relationship. He got scared to death that he was not only going to have to go through the divorce, but then have a child to support and deal with. The thought of interacting with her was very troublesome and frightening to him. He didn't want to have to deal with her, not only as an ex-wife, but as the mother of his child.
His scores on the questionnaire show his areas of struggle and strengths. His personality measured to be Passive-active. His strengths were: A patience (17), C envy (21), D boast (16), G self-seeking (16), and L protects (17). His mid-range scores were: B kind (13), E pride (15), I keep records (14), N hope (14), and P fails (13). His weakest areas were: F rude (12), H easily angered (9), J-K delight in evil (12), M trusts (10) and O perseveres (10). We see that he didn’t have much trouble in patience, envy, boastfulness, selfishness, and protects. But he showed some difficulty in the areas of being kind, spiritually useful to himself or to others, in appearing to be proud, keeps a record of wrong, hopes, and never fails. He had the most difficulty in the areas of being rude, love is not easily angered, also in being negative (J-K), trust in God and perseveres. He had trouble in his attendance to sessions because he was in the medical field in high demand, and inconsistent in his sessions and usually late.
When I took him through these concepts, he wouldn't make any comments or statement of commitment to looking at himself. His personality of being a fence sitter, meant that he had many doubts about his relationship to God. He would ask things like, “How do you know the Scripture is true? How do you know that God's really there?” His commitment to using the steps of patience was shallow to non-existent. He made lots of money, and drove a high-priced luxury car. He lived life for feeling valued by what he did and what he owned. Had the typical status things in toys and clothes that he needed to feel valuable, rather than valued as a creation of God.
The woman had a completely different pattern. Her high scores were: B kind (21), E pride (20), N hopes (21), and P never fails (19). She did not have much trouble with being kind or prideful or having a sense of hope or confidence in God or feeling like a failure. She had some trouble with: C envy (17), D boast (18), F rude (18), I keep a record (17), J-K delight in evil (16), L protect (17), and O perseveres (18). She could be pushy or act prideful, she remembered things, kept records of wrongs, tended to be negative, and didn't necessarily watch what she said. She didn't protect and tended to do a lot on her own strength. Her lowest scores were: A patience (15), G self-seeking (15), H easily angered (12), and M trusts (13).
Being an Active personality, one of her most difficult areas, as you might expect, was in patience. She didn't have much of a process for dealing with things. She went from perception to reaction almost immediately. She also had trouble with being selfish and being easily angered, so her process of dealing with things could push people away or make her appear to be hard. She had trouble with trusts. Her tendency to get him to talk, meant being pushy and demanding by saying, “You need to do this. You need to do that. You need to talk to me. We need to deal with this now.” And he would clam up and pull back. So, when they had their trouble with the miscarriage, her solution was really relatively simple: just deal with the problem. Even though they had problems in their marriage before, she thought they were fixed up to that point. She was shocked when he said that he was going to leave, which sent them to counseling. He began to come at times, but he continued his pattern of being withdrawn. She had some faith in God that I could use to talk to her about the child, and she dealt with that relatively well.
In another case, a grandmother lost a grandchild named Jennifer. When I first met her, she was spending quite a lot of time at the grave, where she would mourn, cry and wail for Jennifer. The grieving process for her had become exaggerated and almost bizarre. As I worked with her about her tendencies, which were passive-active, she was able to accept that Jennifer was alive and well in heaven and she would see her again. She did a lot of work with the Holy Spirit about her emotions. In her case, some of her trouble came from having three daughters each of whom had at least one child without being married. She was grieving for the way her daughters’ lives were going, and the loss of her hopes and dreams for what they could be. None of her children were Christians, and lived unstable and immoral lives. She grieved over the way the grandchildren lived, with the boyfriends who were in and out, and the immoral activity that the children heard and saw. She discovered that was her real focus. The Lord had to help her see what she was really grieving. We talked through her disappointment and how she was responding to that. I got her to a psychiatrist so that she could get some help with medication. She did come out of her grief slowly.
The loss of the child was not the major issue in this case; it was the marriage. It was the man's frustrations and hopes and dreams. He would say things to me like, “I can never trust her again. If she did this once before, she'll do it again.” You see, he was grieving over his expectation of fidelity, and he wasn't willing to look at the potential that he had not been faithful spiritually (remember how that causes insecurity in the woman). His lack of honesty in communication, his unkindness, being easily angered and rude, and his lack of trust in God had been as destructive to her as her adultery had been to him. And he finally quit counseling, and they divorced. The reason he gave was, “I don't care what you say about God. God can't heal this. God can't give me back my trust. It'll never be the same, and I don't want this relationship.” The issue wasn't adultery; it was his spiritual problems. She changed tremendously by becoming much stronger spiritually, through insight into her tendencies to assume things to be black and white, and being a Bone Crusher.
In your own words, answer the following question and submit to see Dr. Dan's answer. This question is for your personal reflection -- no score is given.
When an individual does not have a relationship with God, how do you believe they struggle? How does this relate to someone who has a weak or limited faith in God?
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Dr. Dan's Answer:
When an unbeliever attempts to cope with grief, they are left entirely to humanistic self-reliance to make sense of suffering, tragedy, and death. When faced with the finality of loss or the death of a loved one whose spiritual state is unknown, they cannot find true comfort because they have no assurance that God is fair, trustworthy, and sovereign over all things.
For the weak in faith, their grief can be similar to an unbeliever's -- their thinking and emotions can turn into bitter confusion and despair, leaving them ill-prepared in their hope and daily living. Potentially, they can turn their anger or skepticism toward God and toward other believers.
Contributors in Grief Recovery
The last issue says, Time (you work with the issue of loss over time), this will mean that this type of problem will demand a longer period of time than normal to come to a point of closure with the client. If an average case runs 8 to 12 sessions, this may take 16 to 24 weeks which can be helpful for someone who is grieving. Consider extending the time between sessions after the ninth or tenth meetings. You may need to extend counseling check-ins on a monthly basis, until they express a sense of peace and acceptance over their loss. Yet remember, people do not “get over a loss”; they “learn to walk in their loss”.
The element of time also applies to when, who and how a person died. As you read about, loss of a child is very difficult for parents and grandparents to understand and may happen suddenly. Conversely, when a person has lived a full life and had an extended illness that has given the spouse and family time to prepare for the loss of their loved one generally shortens the time of grief. The extent of time in grieving though is not related to the amount of time the spouse, parents or family members will miss the one who passed, since they will miss the person throughout their life.
Let’s continue our discussion on grieving the loss of a loved one, an object, or a job. Family grief also includes the death of a child either born or pre-born, loss of the life you hoped for your children and grandchildren, loss of a spouse, and parents. You can also grieve loss of work. I mentioned that after a number of years at a firm, that one client (in issue of unemployment) had lost this job and felt a lot of insecurity and experience dysfunction, and lost purpose, friendships, activities, and community. He didn't have a sense of what to do. Another woman lost her job or was forced to resign at a faith-based organization, after using the process of patience, spoke the truth in love and called the leaders to consider some ethical concerns. She grieved her loss of her reputation through false accusations, her confidence in her work ability and faith in Christians who are compromising leaders.
The point of grieving is what really controls it. A large part, ultimately, will be the client’s personality type, his or her relationship to God, and level of spiritual maturity. Also the rumination of what life could’ve, would’ve and should’ve been, only if … (fill in the blank). Accepting the loss of control over life and powerlessness is key. The weaker the trust in God and His Sovereignty, the less confidence the client has in eternal life or that God is fair and trustworthy. This includes clients who are grieving the loss of an unsaved person, trusting the reality that the unsaved person will be judged fairly by God.
So, you can't come to your own conclusions, and that's a point of comfort. When clients ask, “Well, is this person in hell?” You don't have to make a judgment. You can say God's character is fair, that's between that person and God, and that God will not condemn anybody to hell. He will allow us to choose where we spend eternity, but he's not cruel and mean and doesn't hurl lightning bolts. If the grief is over a Christian, then there's a tremendous amount of comfort being at a funeral of a saint. The funeral of a Christian is, in a sense, a celebration, and you can perceive that within the spirit of the people there, or even the Spirit of God there.
At other times, you may work with people who are grieving through a natural catastrophe, something they couldn't control. I was in a flood one time in 1972 in Rapid City, South Dakota, when I was in the Air Force, and I saw a lot of people lose their homes, 1300 in total and 238 people died and over 3000 people were injured. There were people who were trapped inside. It was an instance where a natural earthen dam was overrun with an excessive amount of water from flash floods, and it literally took out a three-street wide path in the center of Rapid City, South Dakota, which is the second largest city in South Dakota. That's not as big as you would think, but I was in the middle of the flood and almost killed myself, and was spared from that. Buildings and homes and people were washed down the street, and you couldn't reach them: they were trapped in their homes. The basements filled up instantly, and there were people sleeping in the basements, because it happened in the middle of the night.
There was one big general question, “Why? Why was this allowed? Why did I lose my husband or wife, and you didn't lose yours. Why was my home 15 feet away untouched, and yours was literally picked up, hurled down the street, shattered into a million splinters and never seen again?” This is another place of grieving, the loss of property and the unfairness of the tragedy, seems to cause different reactions within people. Some will only feel despair and hopelessness while others will be thankful and seek to help others.
I remember one man who restored a classic car over a period of years that was not taken by the flood, but was under about 10 feet of water for a number of days. He had redone everything from the interior to a rebuilt engine. In a flood, silt (real fine dirt) permeates everything. People who tried to just drain the water out of the motor and replace the oil before driving, got about 15 miles, and that silt expanded and froze up every moving mechanical part. The engine became a literal solid chunk of metal that he threw away. This man got so frustrated, that he had taken a pickaxe (which is basically a long, slender piece of steel that's pointed or squared on one end that's attached to a handle), and he started at the hood and put holes in the body about every foot or so, everywhere: the hood, the fenders, the doors, the back quarter panel, the hood, the top, both sides and even broke out everything including headlights, and taillights. He walked away, and called a wrecker to tow it and bury it.
In grief, you see a lot of strange behaviors, frustrations, and attitudes. You need to take them back to look at what they know about God? Are they dealing with just temporary frustration? You know, sometimes with people, you just have to let them go through their choices as to how they respond, and give them some time to work out their emotions and to deal with their frustrations and return to thought and prayer when they're capable of it. Because grief can be so extreme, so intense, and so personal that you don't ever want to say to them, “You've grieved enough. It's time for you to wake up.”
James Dobson explained how he felt that his mother grieved too long when his father died. She explained to him that she had to do this according to the way that she could deal with it. She had lost her best friend, and it was very deep and intense. But when she was ready, had grieved enough, ready to live again, she showed up one day in a bright flower dress, with a smile on her face, and said to him, “I'm ready to live.” And that's a large part of grieving. You have to give the person time to process things. You have to be there as a counselor to help them as they are ready and as it is appropriate. Sometimes you just have to be there and be caring, listen, continue to support and accept them, the way they are made. The Active person will probably try to deal with it, even try to fix it. A passive personality will stay in denial longer and suffer from extreme emotional swings. But the type of personality they have, and their concepts of God will see them through.
You may have to help them gain concepts or strengthen concepts or answer questions. But this issue of grieving is not something that can be dictated by a manual, book, theory or therapy. It's a personal journey of dealing with this loss and then asking God for help. Often people will blame God for allowing or even causing the loss to occur. The most important thing you can do is be with them in it and help them walk through it with an understanding that God is in charge, He will bring joy out of sorrow, and use their suffering for good if they trust Him to. God will make things better, and provide the strength to live on without that loved one present. Reassure them that they didn't really lose the loved one, because that person is in God's care, and they will see them again. If the client is not a Christian, then help them see the benefit of believing in Jesus so that they can have eternal life, where all relationships are eternal. Those who decline to believe in Jesus, only have the gift of knowing person. NOTE: A wonderful program was developed the year Dr. Wilkinson died, 1997, and is effective and available. It is called Grief Share and can be found online at www.griefshare.org. It is Christ based, Biblical and very helpful. The groups meet in local churches and online and can be found through an online search by zip code.
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How does a person's relationship to God and spiritual maturity influence their experience of grief and tragedy?
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Dr. Dan's Answer:
Grief is directly tied to one's trust in God and spiritual maturity, though it is a very emotional, natural process. When individuals have a weak or distorted concept of God -- perhaps viewing Him as unfair, uncaring, or untrustworthy -- their grief often turns into bitter anger, confusion, and despair.
Conversely, when a person trusts in God's fair character and relies on eternal life, using the patience process they are able to acknowledge the truth of their situation, process their emotions, and work with God to find peace and restoration.
Severe or Long Illness
Our next topic is severe or long illness. You will need Case Study 25 in the Materials tab. The symptoms of dysfunction for illness, states it as lethargy, not getting up, getting dressed, leaving the house, and indifference to life. Then, weight loss, which can be just one among many physical symptoms of illness. Next is poor performance in general, at work, at home, with relationships, an inability to do what you used to do to a degree. Next is emotional outburst that can be just pure frustration.
Not too long ago, I managed to get in a motorcycle accident, and I broke my left shoulder blade in half from top to the bottom, and I broke my fourth rib, and I cracked my fifth, sixth and seventh ribs, and had nerve damage in my left hand and my left foot. One of the real simple problems was I could not dress myself for about three weeks. I had to have my wife help me get dressed. I had my arm in a sling for another five weeks for a total of eight weeks. That gets your attention, and brings lots of humility. It happened in a second: on my way home thinking about things that I’m going to do and in the next second, I am flat on my back in the middle of a highway, staring at the sky, at nine o'clock at night, and my whole world has changed! I got frustrated at times. I had emotional outbursts at times. I had to rethink my whole life, my schedule, being places, doing normal things. Driving the car was quite a chore as well as an achievement. I got weary of having only one arm and the constant internal pain.
Illness has a degree of emotion, especially, if you're faced with a long-term illness, or are permanently disabled in some way. Besides normal emotions of frustrations and pain, grieving can also be part of the emotional response. One of the issues in illness is the willingness to accept it. Often it is something you have no control over. Sometimes it is a result of poor choices which could have been averted, but wasn't. Either way there's a degree of accepting the illness without bitterness and anger, or accepting your responsibility for it because of poor choices. Then, in the Treatment Text, it states you can suffer with an alienation from God, or a sense of anger or confusion towards God, which is what I just touched on. And then, the Treatment Text says many of the same issues as with grieving the loss of a loved one, many of those are the same. The difference is that the client is grieving the loss of health, whether temporarily or permanently.
The Treatment Text explains the process of grieving to the individual. There were lots of times when my wife would sit me down and say, “Let's look at the facts and what are you experiencing, and is this normal? And how can you deal with this?” You need to help people understand that they will progress toward healing emotionally and spiritually by purposefully acknowledging the truth of the situation, addressing their emotions of anger and denial, then reaching acceptance, so that they can learn how to cope with this new reality. Counselors call this “normalizing”, an effective way to help a client understand they are feeling like any or most humans feel. Their feelings are not odd or inappropriate and something is wrong with them. They will generally find relief in hearing this. Clients who attend self-help or therapeutic groups will discover the same effect of feeling normal when they hear others are feeling the way they do. Explain that to the client, then add God enables us to go through the emotional process of grieving, in order for us to seek Him to help us deal and cope with it. Even though our own and mankind’s choice to sin brings hardship and suffering, God provides us peace, when we trust Him to help us each moment until we reach His promised Eternal Life, where we will be perfected and restored through Christ.
Case Study 24 deals with the lady who was studying to be a nurse, and had dreams and hopes of marriage and children. Out of the blue, her diabetes got extremely bad. It never had before. It robbed her of her sight, some of her mobility, and her hopes and dreams for the future. There was no way her deams and hopes were going to happen. Because of the diabetes she lost her ability to conceive. Her initial statement to me was, “I don't know how to die, not hate God, and I need you to help me to go through understanding this, accepting this and literally dying.” You obviously have many different issues here, and we'll talk more about them, but one of the realities of treatment is the fact that you have to present the Gospel or help the person strengthen their faith, and you talk to them about death. There's an old saying that I always heard in the military, “There aren’t any atheists in foxholes or lifeboats.” And illness, especially if it's terminal, is a lot like that.
People have a whole different attitude toward God, when they know there's the potential they're going to meet Him real soon. So don't hesitate, talk to them about the Gospel, about salvation, about the facts of eternal life. You want to focus on the Scriptures that state that we will have a body that's like Jesus’ risen body. The Scriptures also explain that we have the capacity with Christ to be powerful and victorious over suffering and death. Your client will need to think and pray about this. But that literally means that, for example, as Jesus appeared in a locked room to the disciples, then so will you have the same ability, that means you can go through solid objects. You will have no restrictions on your movement, as Jesus ascended into heaven and literally, was taken up into the clouds, so you will have that ability. That means, literally, you'll be able to fly.
My wife always teases me saying that I will be riding the ultimate Harley Davidson motorcycle in heaven. And I think that's true. I think that the enjoyment that I personally get out of movement. I feel the wind on my face, the way that things look as you ride by them, the ability to smell the air and to see the sun, to look out over a pasture, or to smell the earth when it's first been plowed, because you're out there in the air on your motorcycle. Or to smell new cut hay, or all the things that are involved in that will be magnified an untold number of times when I have the ability to ascend, just as the Lord did, and this person, likewise, will have that same ability, there will be no restrictions on knowledge. So, all the questions will be answered, because my mind will be freed of the shackles of my earthly existence and the limitations of my human ability to think. So that's some of the realities of eternal life that you want to bring out to the person.
One client I worked with was mostly paralyzed from a degenerative bone disease, so all of his joints were stiff, and he had a hard time eating. He was in a wheelchair, and he accepted Christ. We had to lift him and his wheelchair to set him in the baptismal water, as well as dress and undress him so that he could go through that whole process of being buried in Christ and raised to the newness of life. We’d say, “The day will come when you will have a new body.” He was adventuresome, and one time, we strapped him onto my Harley Davidson. He had never ridden a motorcycle, and I took him for a ride!
There's something very healing, strengthening and encouraging about God's promise of a new, glorified body. Your client needs to know that. The two facets are: 1) in Jesus we have a literal, eternal spiritual life, and this earthly life is temporary, and 2) in our eternal life our body will not be limited, feeble or sick, but enable us to move about unrestricted (Read 1 Corinthians 15). This is not trite. These statements of eternal life in a new body are factual and meant to help the client focus on the fact that all life functions deteriorate over time, regardless of whether you're well or ill at the present time. We're all in that same process. Some deteriorate before others, and some for reasons that are both reasonable and ridiculous. Barring the random accident, each person will decline through the process of aging. At some point, consider further study on the “Theology of Suffering”. Understanding God’s purpose of suffering can prepare counselors to be equipped for deep, challenging and emotional conversations.
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Illness can be a draining and frustrating situation. What types of issues will the client be facing, especially if the illness is long term or permanently crippling?
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Dr. Dan's Answer:
The client will be facing issues such as the adjustment to a new lifestyle, dependence upon others, the loss of freedom to do their activities, contacts, or even friends, a change in financial stability or income, and questions or confusion in relation to God -- determining whether He is evidencing His care or lack of concern in the client's life.
Case Study 24
Treatment Text then says, analyze the client's personality type, coping mechanisms and their concept of God through a questionnaire that applies to the individual loss. In this case, this young woman was living with her parents. She had become bedridden, and they had taken care of her. When I met her, her health had been pretty bad for quite a while. She was unable to eat food and had been kept alive by a feeding tube for about eight months. This was very difficult for her to deal with. I gave her a questionnaire that dealt with her parents, because she tended to get into certain arguments and hassles with her mother and father. Her father tended to be a very strong-willed, gruff, loud, and a somewhat short-tempered man. Her mother tended to be more of an Active personality type person. Do this, do that. You need to listen to me, sort of person. Not really with any malice with either parent, but more of strong-willed people.
Looking at her questionnaire results, we see her highest scores are: B kind (21), C envy (20), D boast (22), G self-seeking (23), and I keep a record (24). She did not have trouble with being kind, envious, boastful, self-seeking or holding grudges (or keeping records of wrong). She had some trouble in being potentially D proud (19), F rude (18), L protect (17), and M trusts (13). She had her most difficulty, though, in being: A patience (10), J-K delight in evil (12), N hopes (12), and O perseveres (10) going on her own strength. She also felt like a failure, P never fails (10). Her personality type is Active-sincere because of her scores, which range from 24 all the way down to 10. This told me that she had pretty good knowledge of God, and her motives were good (sincere).
Her biggest frustrations were that she didn't know God or trust God, but she was trying to think through, and pray and work with God. Because she was bed-ridden and lived 30 miles away, I did phone counseling with her. When I showed her scores, we began to talk about her frustrations and her emotions. She was really quite amazed at what I'd found. I explained the process of patience, and that helped her to sort out things relatively quickly. One of the things she had to do was she had to find a different way to relate to herself, to God, and to people. She explained the process of patience to her parents and told them she wanted to use this for their communication. They had both become Christians many years ago, so that made that much easier. But in this case, she had to request that they all stop being emotional, having fits, getting frustrated and working against each other. Her mother had to agree, due to the client’s poor vision which required everything to be read to her: all of the questions on the questionnaire, the process of patience, and the word studies. As she read this to her daughter, she learned as she read, and became very convinced that this was the proper way for her daughter to get help. She was also able to draw her husband in, and the three of them worked together very closely, which helped them change how they dealt with their problems. They literally began to use the steps of patience.
I explained her Active personality tendencies to be impatient, easily angered, negative, and especially her scores on M through P. All those tell me that you react too quickly. You don't take time to think and pray, even though you really want to. And a lot of your being negative and upset or upsetting others is a result of not taking the time to get to know God, read Scripture, talk with Him and allow the Holy Spirit to help you. I said to her also, “You don't know God very well because you don't trust God. To an excessive amount, you do a lot of things on your own strength (perseverance). You don't believe that God will provide or help you (Hopes). This lack of trust and trying on your own, leads you to feel like a failure. That has to change. You have to get the true picture of who God is, and where he is with you in this illness. He didn't want it for you, but it's happened because of living in a sinful world. God wants to help you deal with it, and work through it.”
She did have a hard time for a while, because this was a very new way to think for her. Remember that her concepts of God were formed through the observed characteristics of her parents. What did happen, though, was that she was very determined, sincere, and committed to finding out the truth rather than living in hopelessness and despair. Within about three or four months of talking weekly with her, she started to come out of this, and actually did very well. She got a lot brighter, and a lot more hopeful. She started attending a church, and one night, she gave a testimony about how God was changing her life, how much hope she had, and how peaceful she felt. Her thoughts of "I just want to die" left her, and she was able to find a new sense of purpose; one of which was to pray for others. And she said, “I pray for you and my pastor and my parents”. And she had a lot of time to do that, and so she did that. She would pray purposely each day for some of the basic things around her that she had allowed to become in just disarray. She began to change.
She began to work on just her physical surroundings, with her mother's help. This made a tremendous difference for her, in her sense of her surroundings, being pleasing, organized, and not cluttered in a mess. Much of her hopelessness resulted from problems that she hadn't dealt with. For example, she loved to read, but could not with her poor vision. She checked on audio books that are provided free by organizations. Because she was more organized and had a process to solve problems in her life, she began to do other things for herself. As she continued to deal more effectively with things, her health improved, and she was able to get off of the feeding tube. She got back some of her strength and became more mobile, which allowed her to get out more in the community and go to church more.
Her appearance changed because she was well enough to wear better clothing and get her hair styled. She was well enough to see a doctor for her vision and get new glasses that improved her vision. Mobility was much less of a problem for her, and in the spring, she was able to come to my office. By Christmas, she was able to come to our home for Christmas dinner. She met several people from church, played with our dog, and sat in front of the fireplace. The infamous Harley ride even happened! She had never ridden on a motorcycle, but we were able to strap her on, and put on a helmet. I was able to go slowly, and she got to ride on the Harley.
There were a lot of changes toward progress. She did still suffer at times with relapses, and was hospitalized maybe once or twice a year. When I would talk to her, I was shocked and amazed at her courage. She would say, “Well, I almost died this time. I almost met the Lord. This time I was in a semi-conscious state for a week.” She didn't call to tell me that happened, but just mentioned it as a matter of conversation. So many things changed for her, even though her illness was permanent and deteriorating. She may not live a long life, but she has peace with it. She knows God's character, and understands that God does not want this for her, but He is in it with her no matter what. That is her constant source of help and comfort. She understands the limitations of this life and the body which mean, sometimes she is just sick, and some days or weeks, she is only able to lay there or drift in and out of consciousness. Even though she doesn't like it, it doesn't mean she's abandoned, or that God doesn't love her. She is right in her soul and mind, and looks forward to life, and to eternal life with no restrictions, and a new body. She has peace with that, which is a real, personal, private reality.
You cannot give this to your client. You can only show them how you have gained strength in your own trials and tribulations. Let them know it is possible, but that they've got to live it and now. But it's the same need for a God who comforts us in all things, and at all times.
In some cases, you will not get this kind of response. For example, one client had a permanent loss through a disability, but he had made the disability much worse through the way he coped with it. He was a very strong-willed person. He had a very demanding father who set up all kinds of rigid expectations for what he should do and how he should do it: pick up 150 pounds, work 16 hours a day, take care of your family, earn $100,000 a year, etc. Even if you are hurt, you should keep working and never let anybody know. He saw the example of his dad, who broke his back and worked for a week after it. Distorted thinking, with no Biblical basis, just self-reliance, was the basis for, “That's the kind of man you have to be if you're going to be a real man.”
I started to challenge his strong will, distorted thinking and he became very angry and incensed. When I suggested he tell his wife when he hurts and the need to hire something done, that includes he talks to her about his restrictions, he said, “I can't do that. That's not what men do, and if I do that, there's a possibility that she won't love me, she might even leave me. You're asking me to ruin my marriage and to wreck my life.” He got so mad at me when I suggested these things that he just quit counseling. One reason that he quit counseling, when I tried to get him to fill out a AQAL, he wouldn't do it. I suspect that some of the reasons were: his pride, impatience, a lack of trust in God, or being easily angered. He was his own worst enemy by not dealing with his illness. He would get emotional, depressed and hopeless when he wanted to do something and realized he couldn’t do it. He was blind to his spiritual condition and stuck in his physical condition, stating “I can't do things. It's never going to change.” Well, part of his injury stayed aggravated because he wouldn't follow the doctor's orders and restrict his movements so that he could heal. But he wouldn't deal with that, and that was a spiritual issue, either willful sin, pride or ignorance, a lack of trusting God.
In some cases, you will have clients who stay ill because they're unwilling to work with their restrictions. I could have driven myself crazy trying to get dressed, when I couldn't put my left arm up in the air or behind my back. I needed to say, “I need help.” It wasn't easy, but it still was necessary. And when I would be tempted to not do that, then I would sense the Holy Spirit caution me, and I would ask him for help to accept my limitation. I did a lot of praying and thinking and crying, and admitting to God I'd been wrong. I had caused this, and I needed to repent and change. But sometimes with illness, the individual is not willing to ask for or accept help. You can't help them, at least at that time. They are not ready. Discerning counselors accept the client’s readiness not to change and pray God will continue to provide them grace to someday change.
You want to remember with illness anything from a mild illness to a terminal illness, your client’s relationship to God is going to be critical. Find out what that is, lead them to salvation or help them to mature or strengthen it. Otherwise, you are doing behavior modification, teaching the client to build coping or self-reliant skills. You may have to confront some of them, because of an issue of sin involved which aggravates the illness and their unwillingness to work with God. In other cases, people may need to work through a temporary illness but with a slow recovery. Whatever the case is, practice patience and kindness, those will be some of the main places to focus on during treatment.
Copyright 1987, 1990, 1993 by Daniel D. Wilkinson. All rights reserved. For more information concerning this material, write to:
The Biblical Christian Counseling Ministries, Inc., 2730 Radcliffe Dr., Florissant, MO 63031.
Any reproduction of this material without the express written consent of the author is prohibited. Printed in the U.S.A..
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Besides basic issues that deal with the inability to live life due to an illness, there may be spiritual issues that the client has to face. What will some of these be, especially in regard to God's caring, fairness, and presence in the client's life during the illness, and how will you respond to him or her?
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Dr. Dan's Answer:
The client may see God as insensitive or punishing him or her for past sins or omissions. The client may also be angry at God and consider Him to be cruel, distant, uninterested, mocking, and unjust.
When the counselor confronts the condition of their heart -- seen in the Analysis Profile -- will they choose to surrender to Him? Will they seek a relationship with God to deal with it, whether healing occurs, an ability is lost, or illness ultimately prevails?
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