P-21 Tony’s story: a theory-building case study of delayed grief

This research was part of a multiple case-study, theory-building project, observing the moments of assimilation and accommodation in clients relearning their post-bereavement world. The aim was to chart moments of therapeutic change in the bereavement counselling process, identifying appropriate therapeutic interventions. The subject, a male client was bereaved by a road traffic death at age 11. He had not effectively grieved until he began counselling 34 years later. The counselling sessions were digitally recorded by the researcher who was also the practitioner. The recordings assisted the practitioner both in observing the client’s struggle between primitive emotions and rational self and encouraging the client to construct new meaning narratives. This approach enabled the client to view his own process; becoming a student of his own psychological change. During weekly counselling sessions, key moments of assimilation and accommodation were observed. The client was able to take these changes into his real world between sessions, and report back on their significance and effectiveness; self-judged by improvements in his perceived psychological wellbeing. There was practitioner/client consensus on key moments and the client stated that the outcomes were life-changing. It would be imprudent to draw conclusions from a single case study. However, a theory-building methodology allows each new case study to add a small degree of confidence to the theory being constructed. There is an omnipresent risk of researcher subjectivity in judging the significance of moments of psychological change. Multiple case studies would allow the theory to be refuted or modified. We call for more counsellors to become practitioner researchers by adopting this observational, theory-building methodology. Working in this way may lead to more focused therapeutic intervention and a concomitant diminution of grief.