Grief counseling

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Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce).

Grief counselors feel that everyone experiences and expresses grief in their own way, often shaped by culture. They believe that it is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. Some may laugh.

Grief counselors hold that one can expect a wide range of emotion and behavior associated with grief. Some counselors believe that in all places and cultures, the grieving person benefits from the support of others.[1] Further, grief counselors believe that where such support is lacking, counseling may provide an avenue for healthy resolution. Grief counselors believe that grief is a process the goal of which is "resolution." The field further believes that where the process of grieving is interrupted, for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, grief can remain unresolved and later resurface as an issue for counseling.

Contents

Counseling

Grief counseling becomes necessary when a person is so disabled by their grief, overwhelmed by loss to the extent that their normal coping processes are disabled or shut down.[2] Grief counseling facilitates expression of emotion and thought about the loss, including sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness.

It includes thinking creatively about the challenges that follow loss and coping with concurrent changes in their lives. Often people feel disorganized, tired, have trouble concentrating, sleep poorly and have vivid dreams, and experience change in appetite. These too are addressed in counseling.

Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person's coping ability. There are considerable resources online covering grief or loss counseling such as the Grief Counseling Resource Guide from the New York State Office of Mental Health.[3]

Grief counseling may be called upon when a person suffers anticipatory grief, for example an intrusive and frequent worry about a loved one whose death is neither imminent nor likely. Anticipatory mourning also occurs when a loved one has a terminal illness. This can handicap that person's ability to stay present whilst simultaneously holding onto, letting go of, and drawing closer to the dying relative.[4]

In March 2007, grief counseling and grief therapy were placed on a list of treatments that have the potential to cause harm in clients in the APS journal, Perspectives on Psychological Science.[5] In particular, individuals experiencing "relatively normal bereavement reactions" may experience worse outcomes after receiving grief counseling.

Grief therapy

There is a distinction between grief counseling and grief therapy. Counseling involves helping people move through uncomplicated, or normal, grief to health and resolution. Grief therapy involves the use of clinical tools for traumatic or complicated grief reactions.[6] This could occur where the grief reaction is prolonged or manifests itself through some bodily or behavioral symptom, or by a grief response outside the range of cultural or psychiatrically defined normality.[7]

Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions,[6] which are usually brought on by the loss of a close person (by separation or death) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence.

They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy. A common area where grief therapy has been extensively applied is with the parents of cancer patients.

Controversies

Efficacy and Iatrogenesis

At present (as of 2008), a controversy exists in the scholarly literature regarding grief therapy's relative efficacy and the possible harm from it (iatrogenesis). Researchers have suggested that people may resort to receiving grief therapy in the absence of complicated (or abnormal) grief reactions and that, in such cases, grief therapy may cause a normal bereavement response to turn pathological.[8] Others have argued that grief therapy is highly effective for people who suffer from unusually prolonged and complicated responses to bereavement.[9]

In March 2007, an article in the APS journal, Perspectives on Psychological Science, included grief counseling and grief therapy on a list of treatments with the potential to cause harm to clients.[10] In particular, individuals experiencing "relatively normal bereavement reactions" were said to be at risk of a worse outcome[clarification needed] after receiving grief counselling. The APS journal article in turn has been criticized in the British Psychological Society's publication the psychologist as lacking scientific rigour.[11]

Validity of "Complicated Grief"

Mental health professionals have questioned whether complicated grief exists.[12][13][14] New diagnostic criteria for "complicated grief" have been proposed for the new DSM, the DSM-V.[15] One argument against creating a classification for "complicated grief" holds that it is not a unique mental disorder. Rather it is a combination of other mental disorders, such as depression, posttraumatic stress disorder, and personality disorders.

Empirical studies have been attempting to convincingly establish the incremental validity of complicated grief.[16] In 2007, George Bonanno and colleagues published a paper describing a study that supports the incremental validity of complicated grief.[17] The paper cautions, "the question of how complicated grief symptoms might be organized diagnostically is still very much open to debate." As this is a current debate in the field, new research on this topic is likely to appear in the scientific literature.

Grief and trauma counseling

Anticipating the impact of loss or trauma (to the extent than any one can), and during and after the events of loss or trauma, each person has unique emotional experiences and ways of coping, of grieving and of reacting or not. Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster both the cost and sometimes the supports are greater.

Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon. These are particularly challenging times for children[18] who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community.

Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary.[19] The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed.

This article addresses counseling with complex grief and trauma,[6] not only complex post-traumatic stress disorder but those conditions of traumatic loss and psychological trauma that for a number of reasons are enduring or disabling. For example, where an adult is periodically immobilised by unwelcome and intrusive recall of the sudden and violent death[20] of a parent in their childhood.

One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.

The post-trauma self

Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the self, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques to best fit the presentation of the problem.

Disruption in the previously supportive bonds of attachment and of the person's ability to manage their own affects challenges traditional, so called 'non-directive' client centered counseling approaches. One example of this paradigm shift in approaches is the Multitheoretical Psychotherapy of Jeff Brooks-Harris.[21]

The post-traumatic self may not be the same person as before.[22] This can be the source of shame, secondary shocks after the event and of grief for the lost unaltered self, which impacts on family and work.[23] Counseling in these circumstances is designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach.[24][25]

See also

References

  1. ^ Nadeau, Janice Winchester: Families Making Sense of Death. Thousand Oaks, CA: Sage, 1998
  2. ^ Neimeyer, Robert: Lessons of Loss: A Guide to Coping. New York: McGraw-Hill, 1998
  3. ^ http://www.omh.ny.gov/omhweb/grief/GriefCounselingResourceGuide.pdf
  4. ^ Rando, Therese A.: Clinical Dimensions of Anticipatory Mourning. Champaign, IL: Research Press, 2000
  5. ^ Lilienfeld, S. O. (2007): "Psychological treatments that cause harm." Perspectives on Psychological Science, 2, 53-70.
  6. ^ a b c Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. Diagnostic Criteria for Traumatic Grief. Death Studies 24 (2000):185–199
  7. ^ Worden, J. William. Grief Counseling and Grief Therapy, 2nd edition. New York: Springer, 1991
  8. ^ Neimeyer, R.A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.
  9. ^ Larson, D.G., & Hoyt, W.T. (2007). What has become of grief counseling? En evaluation of the empirical foundations of the new pessimism. Professional Psychology: Research and Practice, 38(4), 347–355.
  10. ^ Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70.
  11. ^ "When therapy causes harm", by Christian Jarrett, the psychologist, Volume 21, Part I, January 2008.
  12. ^ "Clinical Psychology Review - A case for establishing complicated grief as a distinct mental disorder in DSM-V". ScienceDirect.com. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VB8-4D48XGN-2&_user=18704&_coverDate=10%2F01%2F2004&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1644208314&_rerunOrigin=google&_acct=C000002018&_version=1&_urlVersion=0&_userid=18704&md5=9513ea74b8d948a69bdcc58ece3da9bd&searchtype=a. Retrieved 2012-08-09.
  13. ^ http://baywood.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,2,13;journal,42,246;linkingpublicationresults,1:300329,1
  14. ^ "PsychiatryOnline | FOCUS: The Journal of Lifelong Learning in Psychiatry | Diagnostic Criteria for Complicated Grief Disorder". Focus.psychiatryonline.org. http://focus.psychiatryonline.org/cgi/content/abstract/1/3/290. Retrieved 2012-08-09.
  15. ^ http://www.nytimes.com/2009/09/29/health/29grief.html?_r=3&pagewanted=1&ref=health
  16. ^ Bonanno, G.A. (2006). Is Complicated Grief a Valid Construct? Clinical Psychology: Science and Practice 13 (2), 129–134
  17. ^ http://faculty.tc.columbia.edu/upload/gab38/2007_Bonanno,Neria,Mancini,Coifman,Litz,&Insel.pdf
  18. ^ Kathleen Nader, K. Understanding and Assessing Trauma in Children and Adolescents Measures, Methods, and Youth in Context. Routledge, 2007
  19. ^ The Road to Resilience, APA Pamphlet http://www.apahelpcenter.org/dl/the_road_to_resilience.pdf
  20. ^ Rynearson E.K, Editor: Resilience and Intervention Beyond the Crisis, Routledge, 2006
  21. ^ Brooks-Harris, J. E. (2008). Integrative Multitheoretical Psychotherapy. Boston: Houghton-Mifflin
  22. ^ Wilson J.P, The Posttraumatic Self Restoring Meaning and Wholeness to Personality, Routledge, 2005
  23. ^ Wislon, J.P, Posttraumatic Shame and Guilt, Trauma, Violence, & Abuse, Vol. 7, No. 2, 122-141 (2006) doi:10.1177/1524838005285914 2006 SAGE Publications
  24. ^ Julian D. Ford, Christine A. Courtois, Kathy Steele, Onno van der Hart, Ellert R. S. Nijenhuis Treatment of complex posttraumatic self-dysregulation, Journal of Traumatic Stress Volume 18, Issue 5 , Pages 437 - 447
  25. ^ Paul A. Frewen, Ruth A. Lanius, Toward a Psychobiology of Posttraumatic Self-Dysregulation. Reexperiencing, Hyperarousal, Dissociation, and Emotional Numbing, Annals of the New York Academy of Sciences 1071 (1), 110–124. doi:10.1196/annals.1364.010 (2006)

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