Literature review

The below literature review shows the related aspect face by Mr Raju in his life after his wife
past a way. Two main discussion below highlights what may cause Mr. Raju behave in such a
way pushing himself to one corner and separating himself from others, this may cause by:
1. Aspergers Syndrome
2. Complicated Grief
Review one
Rehabilitation and Vocational Counseling for Adults with Aspergers Syndrome, by Jamie
Schutte from University of Pittsburgh on the 18th April 2008
Adults with Aspergers Disorder, despite being of typical intellectual ability, struggle without
supports in higher education and the workplace. The following literature review begins by
defining the population, specifically the social deficits, restricted and repetitive interests, sensory
issues, executive function deficits, and common co-morbid diagnoses of adults with Aspergers.
Social rehabilitation should revolve around cognitive behavior therapy, social skills groups,
education, and visual assistive technologies that promote generalization of skills. Cognitive
rehabilitation should include modifying the clients sensory environment to improve attention
and visual cues to promote memory and organization. Finally, implications for rehabilitation and
vocational counselors are discussed, including challenges and techniques for promoting success
in higher education and in the workplace. Specifically, the importance of forming a therapeutic
relationship, providing communication and social supports, and matching the job to the client are
highlighted. While this paper reviews interventions and strategies that are generally effective for
adults with Aspergers, each client should be considered on an individual basis and receive
distinctive services and supports.
The counseling technique
The following section will review counseling techniques to use when working with
clients with Aspergers, as well as specifics on how to meet educational and vocational support

needs.
Rehabilitation Counseling Techniques
Clients with Aspergers are likely to derive more benefit from counselors who provide
structure, directions, information, and suggestions than counselors who rely on reflection,
emotional encouragement, and support while clients develop their own solutions to problems. It
follows that cognitive-behavioral therapy (CBT), which, as previously described, has been
adapted for Aspergers and combined with psycho-education to enhance social and empathy
skills, has potential to be effective with this population. CBT is theorized to be a more effective
therapy than psychoanalysis and other psychotherapies that stress symbolic constructs,
introspection, and interpretation (Attwood, 2003; Cardaciotto & Herbert, 2004).
Challenges Individuals with Aspergers are likely seeking therapy as a result of pressure or
encouragement from others in their lives. If things are not going well at home or at work, family
members may suggest the individual seek counseling. Reaching out for help is not a common
reaction to difficulties of people with Aspergers (Ramsay, 2005)
An effective therapeutic relationship is vital to effective counseling. However, it is
difficult to form this relationship with someone whose primary deficits are in understanding and
engaging in social relationships (Ramsay et al., 2005; Hare & Flood, 2000). As previously
discussed, individuals with Aspergers have poor communication skills, making interpretation of
their verbal and non-verbal cues difficult. Clients may have poor eye contact, poor voice
modulation, inappropriate affect, or other idiosyncratic communication tendencies.
Perseverating on one topic or making odd metaphors is not uncommon. On the other hand, the
therapist must be aware that some comments made by clients should be taken entirely literally
(Ramsay et al., 2005).
Finally, be attentive. Even though individuals with Aspergers might not be as cued in to
social niceties as other clients, they have a history of negative social experiences and interacting
with a counselor should not be one of them. People with Aspergers appreciate those who are
reliably present, who make an honest attempt to understand them, and who offer specific and
useful guidance. Ask clients what they think about your, the counselors, statements and
behaviors. This is a useful activity to explore inaccurate interpretations and also for the therapist

to gain credibility as a useful source of information (Ramsay et al., 2005).

In conclusion, the following are five modifications of conventional CBT that will make it
more appropriate and useful for clients with Aspergers:
1. Place emphasis on social and affective education
2. Avoid use of metaphors or abstract concepts in favor or straightforward, literal meaning
3. Be directive
4. Use written and visual material whenever possible
5. Involve someone close to the client as co-therapist in order to learn about the client and to
help the client generalize skills outside of therapy

Review two

Group Counseling for Complicated Grief by Elizabeth A. Para on March 2009

Grief is a universal experience; however, the response to grief is different for many
people. Individuals who have a prolonged or delayed reaction to a loss may develop
complicated grief. The need for therapeutic intervention is important for people suffering
from this type of grief. Group counseling provides a viable option for treating the severe
distress and impairment experienced by these people. This literature review explores three
theoretical approaches to group counseling for complicated grief (psychodynamic,
interpersonal, and cognitivebehavioral) in terms of effectiveness and multicultural concerns.

One type of counseling that has been theorized to be beneficial to

individuals suffering from complicated grief is group counseling. Grief and
loss typically cause people to feel isolated, because complicated grief
reactions may directly affect social support (Ogrodniczuk, Joyce, Piper,

2003). In the event of a loss, family and friends typically express concern
for and assist the grieving individual. However, those experiencing
complicated grief may place excessive demands on their social support
groups. The stress may alienate the social network and isolate the grieving
person. Grief counseling groups seem like an appropriate alternative
source of social support. In addition, groups can provide a means of
catharsis and a place to learn coping skills and stress management
techniques (MacNairSemands, 2004; Piper, et al., 2001; Sikkema, et al.,
2006). Furthermore, grief groups are often brief, which may offer some
relief to the suffering individual (Toth, 1997). The three theoretical
orientations that typically underlie counseling groups for treating
complicated grief are psychodynamic, interpersonal and cognitive
behavioral.

Of the approaches that focus on grief counseling groups, those

utilizing psychodynamic theory have been studied the most (MacNair
Semands, 2004). Psychodynamic group counseling has a strong theoretical
base, and it has been investigated intensely by a group of researchers in
Canada. Piper and colleagues have implemented many shortterm groups

for patients suffering from complicated grief since 1986. The purpose of
such groups is to understand how underlying unresolved conflicts
contribute to current difficulties dealing with loss (Kipnes, et al., 2002;
MacNairSemands, 2004; Piper, et al., 2001). groups.
Interpretive
The primary objective for interpretive group therapy is to enhance
the patients insight about repetitive conflicts (both intrapsychic and
interpersonal) and trauma that are associated with the losses and that are
assumed to serve as impediments to experiencing a normal mourning
process (Piper, et al., 2001, p. 531). In addition, interpretive therapies seek
to help the patients develop a tolerance for ambivalence toward the people
they have lost. The role of the therapist is to create an atmosphere in
which clients can examine conflicts in a hereandnow experience. The
counselor encourages the client to find a balance of tension and comfort,
and helps the client to explore uncomfortable emotions (Ogrodniczuk, et
al., 2003). Instant praise and gratification are withheld with goal of helping
the client to better tolerate anxiety and tension. It is an active,
interpretive, and transferencefocused approach.
Supportive

The primary goal for supportive group therapy is to improve the

patients immediate adaptation to their life situation (Piper, et al., 2001, p.
532). According to this perspective, positive adaptation results from the
provision of support and problem solving techniques. The counselor
creates a climate of gratification so that clients can share common
experiences and feelings, and receive praise for their efforts at coping. The
therapist is active, noninterpretive, and focused on the patients current
interpersonal relationships (Ogrodniczuk, et al., 2003). Supportive
therapies typically are less demanding, depriving, and anxiety arousing
than interpretive therapies. Despite limitations, all three of the theoretical approaches to group
counseling have strong clinical implications. For example, according to
the research, professionals should utilize interventions that provide
guidance to help clients communicate needs to others, suggest adaptive
interpersonal behaviors, and help to clarify expectations for support
(Ogrodniczuk, et al., 2003). These techniques are consistent with the goals
of interpersonal and cognitive behavioral groups. In addition, clinicians
should explore patients impressions of what the lost person did and did
not provide to understand the reluctance to accept the loss (Ogrodniczuk,
Piper, McCallum et al., 2002). As demonstrated by psychodynamic and

interpersonal groups, understanding ambivalence is a critical component

to facilitate change and growth. These applications help counselors to
treat individuals experiencing complicated grief skillfully and effectively.