Personal Guidebook to Grief Recovery

Back To Life! A Personal Grief Guidebook

Back to Life is a comprehensive, quality bereavement handbook. It consists of 73 pages that explore many aspects of grief in detail. There are 19 chapters or lessons, each addressing a different aspect of grief, a coping skill or a strategy for emotional survival. Here you will learn: Good, solid information on how the grief process really works. Which symptoms of grief are normal, and which are dangerous warning signs. Valuable and practical coping skills to help you get through each day. Secrets to getting a good night's restorative sleep without prescription drugs. How to endure the holidays and thoughtless visitors. How to identify and defuse anger, guilt, and regret. Family changes to look for and how to keep your family intact through this. Just the right activities and comforting rituals to help ease you through your darkest days. Tried and true psychological exercises and strategies to help lessen the raw pain. Satisfying and therapeutic creative expressions of grief. Effective memorializing techniques to honor and remember your lost loved one. How to cling to hope and move surely towards brighter days. Continue reading...

Back To Life A Personal Grief Guidebook Summary

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4.6 stars out of 11 votes

Contents: 73 Pages Ebook
Author: Jennie Wright
Official Website: www.recover-from-grief.com
Price: $17.95

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My Back To Life A Personal Grief Guidebook Review

Highly Recommended

Recently several visitors of websites have asked me about this book, which is being promoted quite widely across the Internet. So I bought a copy myself to figure out what all the excitement was about.

All the modules inside this ebook are very detailed and explanatory, there is nothing as comprehensive as this guide.

Loss and Grief in Life

It is not something that happens to us as we live rather, it is life itself. Death is not the only loss a human might experience yet it is often the only loss that is validated as a legitimate grief experience. In our view, any event that involves change is a loss that necessitates the process of grief and transition. A loss event requires that some part of the individual be left behind and grieved for before the process of transition and rebuilding can occur. Loss is defined as the state of being deprived of or being without something one has had, or a detriment or disadvantage from failure to keep, have, or get. Grief is the pain and suffering experienced after loss mourning is a period of time during which signs of grief are shown and bereavement, as discussed by Raphael (1983), is the reaction to the loss of a close relationship. The bereavement experience includes the concept of grief, as pain and suffering must be experienced in order to heal...

Grief Counselling and Grief Resolution

The process of grief is an individual journey. Although losses appear to have similar qualities, and there are universal dimensions of grief, each individual has unique issues to cope with and resolve. No two people grieve in the same manner or on the same timetable. Each individual is influenced by various perspectives at different times during the process. Thus, who comes for counselling, when, and with what issues is always idiosyncratic. When asking the question 'who comes' for counselling, in general it appears to be those who are not able to get needed support from family or friends. This may be a result of not having family nearby, not feeling comfortable sharing deep emotions with family or friends, or the family and friends not being knowledgeable about the grief process and neglecting to provide emotional support.

Illness as a Grieving Process

The bereavement model has been used to help conceptualize the process of adaptation to physical illness and to guide treatment intervention. Schneider (1984) emphasized the need to discover and accept what has both been lost and what has been left, in addition to what is possible that would not have been possible if the loss of health had not occurred (p. 9). It is important to realize that the acceptance of illness is a process and that numerous events (e.g., relapse or developmental transitions) may trigger the grieving process. Ongoing losses in a chronic illness can complicate the process and extend the time needed to grieve. 13-17 Denial can still be present but overall more cognitive awareness of long-term illness consequences Developing a sense of autonomy from family and forming close peer relationships that foster their sense of identity thus may become nonadherent in an effort to regain a sense of control and independence in the medical context Consolidating identity in...

Getting Through the Grieving Process

The process of grieving involves the living person's freeing himself from the hold the departed person has over him and finding new and rewarding patterns in daily living and social interactions. The grieving individual must work through in his own way the pain he feels. True acceptance usually involves expressing expected feelings of sadness and loss, and even unexpected feelings of hostility and guilt that may linger. Mental health professionals have specific short-term strategies (usually requiring eight to ten sessions) for helping people work through the mourning process. By working through a process of allowing the deceased back into our lives, thoughts, and feelings, by making our loved one a part of our lives, rather than apart from them, we can learn to accept our loss, as hard that may be, and move through the process of grieving to acceptance.

PANICSeparation Distress Grief and Social Bonding

Among the most common and powerful human feelings are those related to pain of loss, especially the grief of social loss. This emotional process has been modeled by the study of the neurochemistries that are able to specifically reduce separation distress in young animals isolated from their social support systems (Panksepp, 2003b). The resistance of this emotional system to most psychotropic drugs has been a surprise, with only antidepressants such as imipramine and in some species benzodiazepines having modest effects (Panksepp et al., 1988). The neuropeptides that have yielded very robust and specific effects on animal crying are, in order of efficacy, oxytocin, opioid peptides that activate mu receptors, and prolactin (Panksepp, 1998a).

Session 2 Understanding the Multiple Perspectives of Grief

Introduce this session with comments that promote an understanding of the perspectives involved with loss and the tremendous power of grief. Comments should reflect the fact that every aspect of an individual is affected by a loss event, and that in the process, one must continue to assess which perspective is emerging at the present time and affecting the bereavement experience. The philosophical, spiritual, psychological, sociological, and physical perspectives can emerge at any time and on multiple occasions during the process. However, each time they emerge there will be different issues to address. For example, the spiritual

The Grieving Process Grief with healthy responses

Just as children perceive death differently to adults, children's grief is also distinct. As reviewed above, they have an incomplete understanding of death that impacts their grieving. Additionally, they possess insufficient coping skills, so they have an increased need to rely on others. Finally, children, unlike adults, need to continue their psychosocial development and must learn how to do this alongside their grieving. All of these factors cause children to grieve differently to adults yet this does not mean that they will have complicated grief. Rather, most children experience healthy, productive grief (Fox, 1991). Children who have healthy responses to grief have adults that allow the grieving process to occur. They are permitted to ask questions and are given concise, developmentally appropriate answers. Children with healthy grief have adults that ask questions to determine the child's level of understanding and to correct misinformation. They are also permitted to continue...

Grief with complications

When any of the aforementioned aspects of healthy grieving do not occur, children may experience grief with complications. They do not explore the emotions or the implications of the loss, and therefore do not learn to accommodate the loss into their daily living. As a result, children with complicated grief may manifest maladaptive or regressive behaviours. Dora Black (2002) has revealed pre-morbid characteristics and environments that are risk factors for future grief with complications. Though Table 6.1 appears geared towards children who have lost a parent, it can also be utilized when a child experiences the death of a friend or an adolescent who has experienced either. The age of a child is also a risk factor for complicated grief. Black (2002) states that children less than 10 years of age are at risk because of their inability to comprehend death and its impact. This misunderstanding will then affect each stage of their development. Worse, bereaved children are at risk of...

Reasons for Problems with Grief Resolution

Numerous reasons have been proposed as to why grief becomes complicated or unresolved. Often the risk of developing complications during bereavement depends on both the immediate circumstances of the death and the background against which it occurs. For example, PTSD is more likely to occur following a loss that is traumatic. However, complications can also occur following losses that are not traumatic. Often grief becomes complicated based on how an individual copes with their loss. Those who have not been able to cope with prior losses become more vulnerable to complications with future losses. Thus an individual with a history of inability to cope, emotional difficulties, or a personality disorder is more likely to suffer complicated grief after their bereavement experience ('Complicated Grief', 2006). In addition to the awareness that past difficulties and premorbid issues of personality and functioning can affect present accommodation to loss, bereavement difficulties can also...

When Grief is Not Resolved

The nature and symptoms of unresolved grief have been discussed and debated over the past several decades. Many who have contributed to general models of loss and bereavement have also laid foundations for the conceptualization of unresolved abnormal grief. The focus of this book is on mental health services for uncomplicated grief, yet it is important to understand the limits of one's competence. Therefore, the purpose of this chapter is to broaden an understanding of potential problem areas within the realm of unresolved grief, but not to deal with it in depth. A familiar question that we are asked is 'When is grief not normal ' As a practitioner, it is important to know the boundaries of normalcy, since the manifestations of normal grief often appear to be abnormal. It is important to have relevant criteria for assessment and to understand the limits of interventions. Moreover, counsellors need to know when a client's issues are beyond their professional scope, and a referral is...

Grief Counselling

Bereaved clients (no matter what the loss) may request counselling at any time during the grief process. Usually, it is during a time period of acute pain, frustration, or confusion regarding what to do to feel better. This can be during an early stage of the process or years removed from the actual event. Some clients come within six months after a loss, because they believe that they should be doing better or 'over this by now'. Others come years later, and after several major losses, because they never had the time or the permission to grieve, or because the accumulation of the affects of losses has become overwhelming. The issues that need to be addressed and resolved vary from individual to individual. Some clients simply do not understand the grief process. Thus, education is an important component of counselling. Many come from cultural backgrounds which have negated the grieving process, and so they believe it to be a sign of personal weakness. Others come during a time of...

Family Grief

This chapter discusses various aspects of family grief, with consideration of issues that will be different for each family member. It will illustrate family case examples, but will also ask the reader to keep the individual in mind as a separate entity since most counsellors see clients individually (independent of the family unit) and their bereavement is addressed within that individual context. Every client represents and is influenced by membership in one or more families. These memberships need to be assessed and understood as one deals with the individual. Issues of grief that currently affect the bereaved are often rooted in unresolved, multigenerational family relationships, norms, and patterns of communication. Understanding an individual's loss from a systems perspective provides valuable insight into potential complications in the process.

Children and Grief

Children are not merely small adults. Rather, they possess distinct cognitive, developmental, and emotional constructs that make them distinct from adults. This means that the accepted concepts of grief and bereavement may not apply to children and therefore a distinct approach and interaction are necessitated. Moreover, children vary by age, experience, and their environment. This further solidifies the notion that there is no blueprint from which to seek directions when interacting with the bereaved child. There are, however, patterns of development and grieving that can aid in the counselling of a bereaved child. This chapter seeks to highlight these patterns and provide tools of intervention for the practitioner wishing to aid a grieving child.

Anticipatory Grief

Anticipatory grief is a term that is most often associated with a terminal illness, with a prognosis of impending death within a stated time period. However, anticipatory grief can refer to a process for any loss that is expected in the future. Many illnesses that are not terminal have characteristics of significant change for the individuals and others involved with them. Heart disease, arthritis, and cancer are only a few of the medical conditions that alter lifestyles and have significant personal losses involved. Geographical moves, job changes, and retirement are also significant losses that are not often recognized as such, but require anticipatory work. The list is extensive, and as mentioned in Chapter 1, losses occur from the time one is born until one dies. Many of these losses could be more satisfactorily resolved if time was spent understanding what has already changed and anticipating what is going to be lost, what the potential effects of this loss are, and what one...

Beyond Normal Grief

Not uncommonly, people get stuck in the grieving process. Unable to move through it, someone who is grieving may Delay it by acting as if nothing happened or as if the person has accepted the death easily. It may be years before the person becomes preoccupied with the death and images of the one who died it will be at that time that the grieving process must be worked through. Be socially passive, with the grieving person unable to initiate new activities or relationships because he believes that it will all be unrewarding anyway. Be overgenerous, with the grieving person appearing not to care anymore about money or belongings and perhaps willingly giving them away, possibly hurting family and business associates in the process. Be chronically depressed or have ideas of suicide as a reaction to grief. Suicide may be considered an option if anxiety, panic, or a major depression persist. Sometimes the depressed or anxious person becomes agitated, feeling tense, restless, and worthless,...

Grief Loss Unresolved

Grief's Courageous Journey A Workbook. Oakland, CA New Harbinger Publications. Childs-Gowell, E. (1992). Good Grief Rituals Tools for Healing A Healing Companion. Barrytown, NY Station Hill Press. James, J., & Friedman, R. (1998). The Grief Recovery Handbook The Action Program for Moving Beyond Death, Divorce, and Other Losses. New York HarperCollins. Obershaw, R. (1998). Cry Until You Laugh Comforting Guidance for Coping With Grief. Minneapolis, MN Fairview Publications. Westberg, G. (1986). Good Grief A Constructive Approach to the Problem of Loss. Minneapolis, MN Fortress Press. Zonnebelt-Smeenge, S., & DeVries, R. (1998). Getting to the Other Side of Grief Overcoming the Loss of a Spouse. Grand Rapids, MI Baker.

Philosophical perspective

Philosophical issues are always a part of a grief experience. How an individual lived and previously interacted with his or her world no longer makes sense. Numerous questions about the meaning of one's existence emerge. Attention to the category of loss of some aspect of self is important here. How much of the invested self that has been lost because of this event is a pivotal issue in rebuilding Is this individual willing and capable to look within and find new dimensions of self This question becomes the foundation of ongoing assessment and subsequent intervention strategies. Moreover, loss of some aspect of self also brings attention to the fact that death becomes personalized and real for the survivors. One can no longer hide behind the cloak of immortality. This perspective introduces difficulties of aloneness, meaninglessness, despair, responsibility, and existential anxieties. From a philosophical perspective, one can consider each loss event in life as part of the eventual...

Spiritual perspective

Clients are influenced by their spiritual beliefs (or lack of them). As the categories of loss are explored and a number of losses identified, it is often the observation that the spiritual realm is the only emotional anchor left for survival. Belief in an afterlife often provides a reason for going on and the hope of reunion with a loved one. However, spiritual beliefs and or the tenets of organized religions may also be the source of fear and guilt. Often individuals may believe that a loss is a sign of punishment from God for some wrong that has been committed. Believing this, additional guilt is often imposed upon the grief, and the bereaved can have a tendency to see themselves as bad and not worthy of forgiveness for past wrongs. An understanding of this perspective in a client's life is essential. During times of loss, conflicted beliefs or a lack of spirituality can become additional issues for an individual.

Sociologicalcultural perspective

This perspective greatly influences how one grieves or fails to grieve, and encompasses the impact that one's culture has on the bereaved. A culture society establishes norms, many of which are unspoken but exert subtle (or not too subtle) pressures for conformity and prescriptions for belief systems and behaviours. Today we are influenced by past and present cultures, and as we look towards a new century, there is evidence of ideological shifts and some return to former beliefs and behaviours. There is a growing opinion that past emphasis on scientific rationality for answers in this century has created new problems that need new solutions. Within the field of loss and grief work, there is a growing awareness of the need for support systems, renewed emphasis on spirituality (a view especially held from a fundamentalist religious standpoint), and a return to the use of rituals during times of loss and transition. In the sociological cultural perspective it is also important to...

Assessment Strategies

The purpose of assessment is to gain entry into the client's inner world and to understand the unique experience of grief as influenced by present and past losses and the contributions from the various perspectives. Assessment is an ongoing process and should never be considered completed simply because the initial intake has been done. Assessment and intervention go together throughout the sessions, with one paving the way for the other. Assessments allow for the next interventions to be planned for and interventions facilitate change, which prompts new issues to emerge.

Pre Counselling Assessment

The first assessment starts with the telephone call from the client requesting counselling services. A pre-counselling intake form (Table 2.1) is used. This form identifies the type of loss whether or not the client is presently receiving other counselling services what the current feelings are and if there are personal changes in habits such as eating, sleeping, or alcohol drug use. After a significant loss many express feelings of not wanting to live any more. Thus, an initial assessment is necessary to determine if the statement is within the normal grief experience or if there is a level of lethality to the suicidal ideation. Other questions help to determine the mental and emotional status of the client and the need for immediate intervention. A question on gender preference has proven to be important, as a number of clients have suffered some type of abuse but hesitate to request a male or female. Having some of this basic information before seeing the client for the first time...

Perspectives on Loss

Designing questions around various perspectives on loss initiates the counsellor's process of joining with the client in order to understand more fully the totality of the individual's grief experience. Table 2.3 (see page 22) illustrates the several perspectives discussed in Chapter 1, with different loss examples given for each perspective. In an actual assessment, the counsellor takes the one loss issue presented initially by the client, and pursues the line of questioning across each perspective. SIGNIFICANT DATES THAT HAVE THE POTENTIAL TO TRIGGER GRIEF REACTIONS (Examples holidays, birthdays, anniversaries, special events)

Family Concepts within the Family Therapy Approach

Not every family, or individual within a family, will need counselling however, an understanding of the major theoretical concepts of family will prove valuable in the counsellor's general understanding of the relationship of an individual within a family or families to concepts of bereavement. Family therapy has incorporated theory from various disciplines, including concepts from systems theories, structural approaches, symbolic interaction, and attachment theory and styles, and constructivism. All of these offer insights and tools for assessments and interventions, and can be adapted to counselling for those experiencing loss and grief.

Attachment theory and styles of attachment

Chapter one discussed the relationship of Bowlby's (1969) attachment theory to concepts of loss and grief. Building on this conceptual framework, Kissane and Bloch (2002) proposed that this theory can be applied to an understanding of a family and their reactions to loss. They included concepts of attachment style, originally proposed by Ainsworth (Ainsworth et al., 1978) in her description of attachments in early childhood. Secure attachments imply the ability of children who are comfortable to independently explore their environments as they know that their parents will return and welcome them. Insecure attachments suggest the opposite behaviours and expectations. Avoidant, ambivalent, and disorganized are the three patterns that can be observed. The authors first utilized these concepts as they explored family response under the threat of cancer. The notion is that a life-threatening illness activates a threat of separation and loss. Illness and death of a family member reproduce a...

Additional strategies

Additional interventions for families can be adapted from individual and group assessment and counselling strategies discussed in Chapters 2, 3, and 5. Noteworthy among them is the use of rituals. Rituals are behaviours designed by the bereaved that encourage expression of difficult emotions and promote opportunities of transition during the grieving process. Families need to grieve the death of the family system as it was formerly known as well as the loss of the individual before they can reconstruct a new family identity. Writing a family letter to their loved one, sharing memories, commemorating, and passing down treasured objects are all therapeutic and effective in promoting family healing and reconstruction. Lastly, counsellors are reminded that an important component of their services is education. Individuals and families often do not understand their grief as it relates to themselves or to their families as a whole. Knowledge is power. Information from a professional often...

Death of a partner in a gaylesbian relationship

The loss of a partner in a gay lesbian relationship may be significantly different than a death in heterosexual relationships. Often the relationship has not been accepted by society or the extended families. As a result, rituals for funerals and ongoing bereavement services are not legitimized. Disenfranchised grief is often inherent in these deaths, making them lonely losses that are more difficult to resolve. Even before the death, especially if there has been a lengthy illness, there often is a lack of supportive resources available to these couples families. Considering these and other possible issues, counsellors should initially evaluate current systems of support and be prepared to understand the variety of issues that these couples must contend with. His family responded, and during the two remaining years they visited frequently. At first there was hesitancy to honestly discuss issues and emotions that had been repressed by all members of this family over time. Les felt that...

Death of a grandparent when grandparent has been primary parentcaregiver

For various reasons and circumstances, grandparents have assumed parenting roles for their grandchildren. Often an adult child returns home after a relationship ends, works outside the home, and depends on a parent grandparent to take on a caregiver role. Other times a biological parent might be declared emotionally or physically unable to care for their own children and the grandparents are given legal custody. Reconstructed families that put grandparents into parental roles have the potential to provide consistent nurturing environments and secure attachments that are crucial for a child's development. However, based on the age and well-being of the grandparents, these situations may present a threat of an additional loss. For youth who are still dependent on adults, losing a grandparent during this time creates additional developmental complications and risks. Thus, assessment and treatment strategies for these individuals must consider normal developmental tasks, family structure...

Adult 10week Support Group

The adult 10-week group is semi-structured. Each session has a theme related to grief, the process, and potential resolution however, individual needs are addressed as they emerge, and the facilitator must be flexible enough and trust the group process to put the agenda aside as needed. The group has closed membership (8 to 12), with specific goals and objectives for each session. Although a grief group is mainly supportive, it also has the goal of education, or imparting information as described by Yalom. The educational portion of the group sessions is an essential component of intervention as there is often a lack of accurate information about the grief process. Information shared not only validates and normalizes the grief experience, it also educates regarding healthy ways of expression and resolution.

Selection and screening

This group is intended for those individuals who are experiencing grief following the death of a significant person in their lives. The group is not intended for those who have additional and perhaps more intense issues other than grief. Examples would be intense anger, guilt, or prior issues that may need individual counselling. Moreover, those who are involved in legal or business matters following the death of a loved one may be too preoccupied to focus on the work involved in the grief process in general and the group work in particular. Lastly, it is advisable to suggest waiting one to two months before joining a group. There is either an initial period of numbness or unreality or there is intense, acute grief requiring individual attention that lasts for this period after a death.

Special considerations

The facilitator is relatively directive during this session. Guidelines are set and expectations checked. Members want to know if they will get their needs met in this group. Many start to compare their grief with other members. Occasionally, negative judgment will be expressed 'What is she doing here I lost my child and she only lost her 95-year-old mother who lived a full life.' If this occurs during the group session, you as the counsellor can choose to ignore it with the understanding that this is normal and that it will change in the next few weeks or you can address it as it happens within the here-and-now context of the group. You can acknowledge what you have heard and state that this is a normal reaction until members get to know each other better but validate the feeling and concern that are being expressed. Often reactions such as these are expressed to the counsellor outside the group. In these situations acceptance of their feelings is appropriate, with the acknowledgment...

Session 3 Remembering

Part of grief resolution entails the development of a realistic memory of the narrative of lives that have been shared. Many only remember the best features of an individual or relationship. Others become stuck in the memory of the illness or the death event that might have been traumatic. And for some, they cannot think of any positive aspects of the deceased's life. In order to emotionally establish an inner reality and to build a new relationship with the deceased, all the aspects of that individual must be remembered. Remembering, as an active part of the grief work, addresses the need to tell the story of a loved one's life. In this session the group members are encouraged to share pictures, items, or stories (positive and negative) about their loved ones. They describe memories that reflect the fact that we are all human, with human strengths and with frailties that often cause frustration. Through sharing, members allow others into their world. This session is often the pivotal...

Session 4 Identifying and Expressing Feelings

To introduce the theme for this session, focus on the need to identify and express all feelings. Explain that avoidance of difficult and painful feelings is one of the common problems associated with the healing process. In acute phases of grief one feels out of control, and there is a fear of losing more control if feelings are allowed to emerge. Moreover, many do not even know what they are feeling. To facilitate awareness of issues feelings of commonality, participants are encouraged to share the experience of writing the letter or the reasons for not being able to accomplish the assignment. Once a person can identify specific feelings and acknowledge them and then be provided with an environment for healthy expression, one of the most difficult aspects of grief work has begun. It is a paradox that one can 'lean into the pain' and feel relief and renewed energy. Avoidance depletes energy. Grief work is hard work, and one needs purposeful breaks. Not to grieve or experience the pain...

Session 5 Role Changes and Meaning Reconstruction

Bereaved individuals are acutely aware of the physical loss of a person. An important aspect of group work is to address the number of roles or functions that are also lost (i.e., intangible losses) after the death of a significant person. A person is not merely a friend, a child, a parent, or sibling. Relationships provide meaningful roles and are the basis of one's identity. A goal of the session is to help members explore the roles that have been lost or redefined. This is not intended to add more grief or to promote self-pity. When taking into consideration one's sense of identity and narrative coherence, the bereaved must understand all that has been lost in order to reorganize their lives with some sense of meaningfulness and continuity to the past (refer to Chapter 1 for narrative constructs). As members begin to understand the changes in functions and roles as a result of their loss, they are cautioned not to perform all the roles alone. However, they are also cautioned not to...

Session 7 Coping including coping with holidays birthdays special events

Specifically, holidays and special events are highlighted as intense periods of stress and potential emotional pain. They cannot be avoided, and they need to be carefully preplanned. Holidays and special events have the potential to arouse a multitude of past memories, many very painful. Preplanning with other family members can be instrumental in avoiding unnecessary grief

Session 8 Memorialization Continuing Bonds Inner Representations and Interactive Relationships and Therapeutic Use of

Rituals (Rando, 1988) can be utilized to facilitate memorialization and an inner representation of a loved one. During this group session, members learn about the relationship between rituals, tasks of grief, and grief resolution. They are encouraged to begin to identify where they are in the process and tasks of grief, and to explore possibilities for personal rituals. The behaviour (ritual) is designed to express internal feelings of grief in order that others may better understand the depth and nature of the grief. A ritual may be done once, as in the ritual of the funeral, or it may be repeated. A ritual is structured and has a time limit. Thus family and friends may be more willing to participate if they understand exactly what is expected of them, and that there is an end point. Often support persons abandon the bereaved because they tire of endless grief, and they do not know what to do to help. Rituals provide a framework and a channel for emotional energy. They should be...

Session 10 Closure Celebration of Life

Open this session with statements of appreciation for each member and the risks that they have taken to share their pain with each other. Validate the fact that you have observed growth and change in everyone over the past ten weeks. Acknowledge the fact that today is the formal end of this group and that this often brings up additional feelings of loss and grief. Share the fact that many in the past have chosen to continue to meet informally and have benefited from ongoing mutual support.

Day 1 Understanding what happened and why

Introducing the balance between grief work and play. Interventions 4. The first day was particularly difficult, as many kids had never verbalized their story. In anticipation of this, frequent breaks and a challenge activity were scheduled into the day. The frequent breaks allowed children to play and re-energize. It also showed them that it is ok to have fun amidst their grief work. The challenge activity was an important aspect, for when conquered, it affirmed a sense of control and autonomy. The challenge activity showed them that they can face a challenge such as grieving and come out successful and in control.

Day 2 Identification of feelings in a healthy way

As implied, day 2 focused on the myriad of emotions associated with the death of a loved one. Adults often do not acknowledge the breadth of emotions experienced by bereaved children, for they either do not realize that children can experience them or they do not wish children to be experiencing difficult emotions. However, children do have these emotions, and in order to perpetuate healthy grief and development they need to recognize these feelings and develop skills of coping with them throughout their development. 4. Happiness should remain amongst a grieving child's emotional range. Thus, the camp continued to focus on joy by providing structured play sessions. Additionally, the day's challenge activity was a scavenger hunt that allowed children to forget their work and discover happiness as they sought the hidden treasure.

Day 3 Coping and identification of harder emotions

This day's theme focused on the darker feelings of grief - stress and anger. These emotions play an integral role in a bereaved child's life and therefore need to be acknowledged and accepted. Moreover, a child must learn the correct coping tools so that he can learn how to live effectively with these emotions. Thus, day 3 was devoted to stress and anger. Activities and discussions were designed to allow the campers to acknowledge and cope with these negative emotions.

Day 5 Remember always and go on living

The difficulty of saying goodbye during day 4 was complemented by day 5's theme - always remembering. Adopting Silverman and Nickman's concepts (1996b) that healthy grief is to accommodate the loss in meaningful ways, the goal of day 5 was to discover ways to go on remembering their loved ones on a daily basis.

Camp Lost and Found followup

Though the camp ended, the relationships formed during the week did not. The Grief Support and Education Center held monthly meetings for each of the campers and their families. These meetings had four major focuses The meetings were held at restaurants to encourage a sense of fun and sociality. Similarly, families were encouraged to make additional play dates amongst themselves to re-enforce the identity of the group and the sense of a safe haven. During the meetings, activities were designed to reinforce resiliency and other coping skills. Finally, the grief director and counsellors were present to assess each participant's mood and state. If concerns arose, the participant was encouraged to have individual counselling sessions.

Definitions and Conceptions

Rando (1986) discussed the fact that there are no precise and consistent definitions of this type of grief. Acknowledging this, she first outlined what it is not. One error is to assume that because a person is terminally ill, anticipatory grief is present. Many patients and families in hospice programs continue to deny the impending death or to hope that a recovery might yet be possible. Another is that anticipatory grief is post-death grief begun earlier, or that there is a fixed volume of grief to be experienced and that anticipatory grief will reduce the amount necessary to be experienced after the loss. Findings from Glick et al. (1974) have validated that grief after an unanticipated loss differs in form and duration from one that is anticipated. The reason for this is that a loss that is unexpected has the potential to overwhelm the individual's adaptive capacities to accommodate, thus affecting abilities to function and recover. With sudden loss, the bereaved are often left on...

Palliative care programs

Similar organizational efforts and concerns exist in the United States. Despite some difficulties, the number of hospital-owned palliative care programs has increased by 75 percent between 2000 and 2004. Physicians have become comfortable including a palliative care consultant as part of the interdisciplinary treatment team. The focus now is on assuring consistently high standards in these programs. As a result, the National Consensus Project for quality palliative care has issued guidelines for having interdisciplinary teams, making grief and bereavement services available, and providing evidence-based pain and symptom relief services. However, similar to the United Kingdom and other countries, funding is a major problem in the United States. Insurance companies do not see palliative care services (in the home) as reimbursable, many hospitals do not see any financial benefits for these services, and programs of medical fellowships do not offer funding for training. Palliative care...

Issues for Children and Adolescents who have Lifethreatening Chronic or Terminal Illnesses

Fox (1991) discussed various issues and concerns with this population and suggested methods of intervention. She proposed that pre-school age children would be concerned with four anticipatory grief issues causality of their illness, concerns regarding their bodies, anxieties over treatments, and a pervasive fear of dying.

Early Loss of a Child Miscarriage and Perinatal Deaths

Parental loss of a child, as discussed in Chapter 4, is one of the most difficult and intense losses to cope with. The age of the child will bring unique issues along with it however, one of the most unrecognized losses within the broader category of parental loss is miscarriage, stillborns, and other early deaths following childbirth. These losses have been called 'lonely' because often the mother has been left to grieve the death of her child alone. Often parents must say goodbye to their child before they even say hello. If the father has not bonded with the child during pregnancy, it is often difficult for him to grieve, or to understand what his wife is experiencing. For all, the grief process is more difficult because what is being grieved often is a dream. How one grieves and the specific issues to be addressed will relate strongly to how the parents had fantasized the child. A wished-for child may have represented various hopes and expectations. Many pregnancies are...

Reference to Theoretical Models Introduced in Chapter

Freud's conceptualization of loss, grief, and resolution focused on the acknowledgment and acceptance by the ego that the object had been lost, that the energy that had been used to maintain the attachment had been withdrawn, and that energy to make new attachments had been mobilized. He stated that grief is hard work and takes a considerable amount of time however, unresolved grief is a different issue. He did not base his theory of unresolved or pathological grief on the amount of time it took to complete the process instead, in Mourning and Melancholia (1914 1957) he proposed that ambivalence in a relationship can be the root cause of unresolved grief and mourning. 'Melancholia' was a term that he used for psychiatric depression, and he stated that this condition may be caused by the real or symbolic loss of a person. According to his theory, the lost person is incorporated in some manner within the bereaved individual. Once this has been accomplished, the bereaved can then...

Books on Loss Including Death

Amityville, NY Baywood. This book emphasizes common concerns shared by all humanity while at the same time emphasizing cultural differences and the variety in the ways that people experience death and grief. Littlewood, J. (1992). Aspects of Grief Bereavement in adult life. London Routledge. Looks at the importance of support networks, both family and professional, and how society's attitudes affect our ability to cope. Broad view of diverse contemporary approaches to bereavement, examining both normal adaptation and complicated manifestations of grief. American Psychiatric Press. This book distinguishes between 'normal' and pathological grief. Includes the varied reasons for an individual crossing the boundary, spousal grief and adjustment to widowhood, inventories and measures of grief and distress, and psychoendocrine and immune functions during bereavement.

Books Focused on Children

When a Friend Dies. Minneapolis, MN Free Spirit. A self-help book for teens about grieving and healing. (For ages 11 and up.) Hipp, E. (1995). Help for the Hard Times. Center City, MN Hazelden. This book is for adolescents experiencing losses of many kinds. It explains types and experiences of losses and ways to navigate through grief, grow through the hard times and heal. Moser, A. (1996). Don't Despair on Thursdays. Kansas City, KS Landmark. The grief process is explained to children (ages 5-10) and helps them understand that grieving is a normal response. In addition, children learn that grief will last more than just a few days or weeks. The author offers practical approaches and easy-to-follow methods that children can use day by day to cope with the emotional pain they feel. Wolfelt, A.D. (1996). How I Feel A coloring book for grieving children. Batesville, IN Batesville Management Services. A coloring book designed for children ages 3-8 that presents many...

Bibliographies and Publishing Houses

Tel (215) 625-2919 www.taylorandfrancisgroup.com. Offers several books, video and audio tapes, and leader manuals for groups dealing with grief and loss. An internet website which offers over 400 books, videos, and audios to help children and adults through serious illness, death and dying, grief, bereavement, and losses of all kinds including divorce, suicide, trauma, and violence.

Community interventions

When there is a grieving child, a community continues to have a crucial role. It can provide financial support and human resources for the microsystems that surround a grieving child. It can also create microsystems for grieving children to ensure that they experience healthy grief and that their skills of resiliency are optimized. Examples of such microsystems are Winston's Wish and Camp Lost and Found.

Psychological perspective

Another consideration within this perspective is the idea that relationships are not created in a linear fashion. Raphael (1983) discusses the psychological work of undoing the bonds that created the relationship. She discusses this task of undoing as an integral process of reversing all that has gone into building a relationship. The many layers that were internalized into the complex, multidimensional image of the loved one or role are now reviewed. Moreover, the emotional components that made it valuable (positive) or painful (negative) must also be reviewed. Until one can address the multiple levels of connectedness, it is difficult to address the normal tasks and processes of grief. A poignant example of this is the grief of a parent following the death of a child. The layers of a parental relationship are often complex and conflicted. There are few other relationships that demand such an investment of self and have the potential for complications following the end of a...

Session 9 Assessing Support Systems and Rebuilding and Reconstruction

Support is needed in many different ways over the course of bereavement. Without good support systems the grieving process is even more difficult. As the bereaved move from the acute phases of grief, they are often in a position to help support others. It can be noted that helping others is itself healing - the helper becomes helped. This effort often complements the grief process and begins the next phase of rebuilding. In addition, this facilitates other aspects of resiliency (I AM, I CAN). Rebuilding and reconstructing new identities cannot come before the pain of grief is fully experienced, yet many try to rush through this as if it were another 'daily' task to be accomplished. This is an active process that implies accommodation and assimilation. The goal is for the bereaved to regain a sense of empowerment and control.

Distorted and conflicted mourning

Distorted and conflicted mourning have similarities. Conflicted mourning is highlighted by ambivalence in a relationship. Distorted grief also involves ambivalence however, what differentiates the two is the intensity of specific emotions in the latter. Intense manifestations of guilt and anger are the primary grief responses in distorted grief. Research from Parkes and Weiss (1983) and Rando (1993) offers insight into these mourning responses. All human relationships have ambivalence (i.e., love, hate features). Bereaved individuals often have to deal with feelings of guilt after a death because they loved the person who died, but also disliked him or her at times. In conflicted grief the degree or intensity of ambivalence is much stronger and more difficult to resolve. The death of a child is an example when both conflicted and distorted grief can occur. Parents invest a great degree of themselves in their children. Children represent the best and the worst features of the parents....

Evolution of Models of Loss and Bereavement

Models and theories have attempted to explain the complex process experienced after significant loss and change in our lives. Evaluating the models of bereavement over time shows more of an evolution of theory and practice than the creation of distinct models. The focus has gone from theories of attachment and loss, to concepts of acute grief, to tasks, to stages, to psychological processes and phases. There are numerous models and it is beyond the scope of this book to identify all of them or to discuss any one in detail. The intent is to identify several that have been particularly influential and useful to persons who counsel others in their loss and grief. From Freud on there has been an emphasis on personal attachment to objects and people, and the giving up of some part of self following a loss (death or non-death) event. Attention to this loss of some aspect of self is an integral part of grief resolution however, it is the part that is often negated and avoided today. During...

Theories of Death Conceptualization

Modern theorists such as Fox (1988), though, believe in a task-based path to death conceptualization. The sub-concepts of universality, irreversibility, and non-functionality are viewed as tasks that are revisited at every developmental milestone of a child's life and accommodated into current schemata. Thus, at each milestone a bereaved child must simultaneously re-evaluate the loss with a new level of understanding and emotionally experience grief appropriate for their present age. The following section is devoted to reviewing how children of various ages experience the loss, what healthy grieving constitutes, and how professionals can help a child grieve.

Arenas for intervention the Bronfenbrenner model

There is the adage that it takes a village to raise a child. Similarly, it can be stated that it takes a community to heal a bereaved child. This sentiment is embodied by school counsellors, ministers, and neighbors who rally around bereaved children in their time of need. Children who best maximize this support are those with the resiliency skills to maximize the support provided by the community. However, if the child lacks resiliency, then the community should create a bereavement environment that allows the acquisition of resiliency skills to occur concomitantly with the tasks of grieving in order to minimize the complications of grief. Bonnie Benard (1991) stresses three touch points when designing environments that foster resiliency. These are to provide care and support for the child, set high expectations for him or her, and elicit his or her participation. Such tasks can be woven into the ecology systems model to create a workable system that fosters resiliency. When dealing...

Session 1 Getting Acquainted and Goal Setting

Risk to explore their grief and share it with others who are strangers. State that care will be given to understand and address each member's particular grief and their ability to cope with it at the present time. Point out that there is no one right way to grieve and that members should not compare themselves with each other or believe that someone else is doing better in their grief work. Encourage members with words that express hope for emotional improvement. Comments such as 'Tonight everyone is quiet and somewhat fearful. In two to three weeks, there will be talking and laughter among you. As a matter of fact, it will become difficult for me to get your attention. I know that you might find this difficult to believe now, but this will happen.' The letter shared by a member in the beginning of this chapter can be read at this point for additional encouragement.

Absence inhibition or delay of bereavement

Delayed grief is grief which is not manifested at the time of loss. When it emerges, sometimes years later, it is as fresh and intense as if the loss had just occurred. An example of this is when a loss, such as a death, occurs in the life of a child and well-meaning adults attempt to protect the child from pain and never discuss the death. Some time later, an unrelated event can trigger the memory of the death, and the grief emerges as if the loss is presently happening. Inhibited mourning has some similarities to delayed grief. However, unique to inhibited mourning is the avoidance of particular issues associated with the loss, and selective attention to others. In addition to Raphael's work, significant contributions have been made by Deutsch (1937) and Bowlby (1980). These theorists agree that these manifestations of inappropriate mourning are often a result of negative and highly ambivalent relationships. A typical example is the adult child idealizing the...

Therapeutic Factors in Groups

Individuals attending a grief group have the opportunity to experience many of the above-mentioned influences. Instillation of hope occurs as members observe positive changes in each other and anticipate forward movement in their own process of bereavement. As they take risks to fully experience the pain of grief, they come to understand that the pain will not further destroy them rather, the pain becomes a healing element. The universality of some of the common aspects of grief promotes a bonding and a sense that one is not alone in grief. However, although grief is the common denominator, initially individual differences will need attention. Members may not be experiencing the same type of death, nor the same issues. Even within a family, no two family members will have the same grief experience. The relationship each person has had with the deceased has been different, and the various perspectives discussed in Chapters 1, 2, and 3 will influence each person's grief process in a...

Resolution and Growth

Within the broader considerations of resolution there is an understanding and an acceptance that life will never be the same again and that certain realities and assumptions must be relinquished in order to survive the pain, to integrate the experience, and to rebuild a future existence. Resolution, like reinvestment, is not replacement. This notion may be difficult for a client to comprehend. Many modern societies are based upon the replacement of objects and relationships. Often grief counselling must address current philosophies of the society culture of the bereaved. Nothing, whether it was a relationship or an activity (e.g., job), that was lost is ever replaced. A meaningful part of an identity and investment of time is never replaced it is reorganized after grief and incorporated in memory in a manner that has potential to console and be growth-producing. That which has been lost is integrated within, and is always a part of the human spirit. Grief has the potential to be a...

Agebased Conceptualization of Death and its Behavioural Manifestations

A task-based theory to death conceptualization implies individuality to each child's death awareness. Still, generalizations can be made based on observations, studies, and developmental theories. These generalizations are important, for they provide a framework with which to observe and interact with a grieving child. They are also milestones that grieving children must acquire to assure healthy development. Adolescents have a sophisticated understanding of death, yet are at risk of complicated grief because of their developmental needs. Erik Erikson (1980) stated that adolescents must define their identify or risk role confusion. Adolescents define themselves by exploring their capabilities, social identity, and beliefs. They engage in risk-taking behaviours to identity their own limitations, and in doing so learn their capabilities. Adolescents also seek friends and social situations to refine their personality. They look to their peers for acceptance and feedback. Finally, healthy...

Communications Systems and Structural Theories

Included within family systems and structural theories are concepts of family patterns of relating and communicating, and dimensions of family functioning. Kissane and Bloch (1994) clinically observed and conducted systemic research on family grief. Thirteen families were covered in their report that indicated an association between avoidance of grief and family dysfunction. The family patterns that were most evident from their studies were an adaptive family response and three maladaptive responses. Adaptive responses, initially described by Raphael (1984), include an open and honest disclosure of feelings. There is an ability and willingness to be intimate with each other, share their distress, and provide support and mutual consolation. These families operate flexibly and allow for individual differences in their members' grief experience. Moreover, they are capable of taking on needed roles and tasks to restructure the family's meaning. lingering virus. At the time of diagnosis it...

Day 4 Need to say goodbye in meaningful and personal ways

Bereaved children are often shielded from the death and funeral of a loved one. The grieving adult is often overwhelmed with his or her own emotions and wants to shield their child by keeping him or her away from the hospital or funeral. However, as previously stated in this chapter, many children are concrete thinkers with a limited ability to comprehend death. Therefore, many benefit by tangible evidence such as a funeral. Funerals can also reveal how to have a meaningful goodbye. Day 4 of the camp focused on demystifying the funeral process and learning how to say goodbye in meaningful ways. 3. Reassurance that it is ok to cry and then laugh while dealing with difficult tasks like grief.

Strategies for assessment and intervention

Based on the constructs discussed, an initial consideration for assessment is to determine present and past individual and family functioning. Effective strategies are based on a clear understanding of pre-morbid functioning. One of the first areas to evaluate is an individual's prior independence and differentiation from their family of origin in which the loss has occurred. As stated, families in grief are more vulnerable and have the tendency to become less differentiated as individuals. In order to communicate and share expressions of grief, this can be viewed as a positive move. Healthy families will revert in time back to being differentiated however, dysfunctional families will remain in fusion. Grief produces anxiety. Life has changed. How one functions in his or her predictable world is no longer the same. It is understandable that anxiety and a severe sense of loss of control will initially dominate the grief experience. Thus family members have the tendency to reunite and...

Issues Related to Anticipated Losses Other than Impending Death

And to grieve it before the new can be embraced. Grief is one of the primary emotions within Gestalt theory, as it is viewed as 'the emotion necessary to the process of destructuring within the gestalt cycle. Grief is necessary to living, as it is the emotional reaction to the losses we know during times of change' (Clark, 1985 50). Coping with illness, especially that which is chronic or life-threatening, has several aspects of loss to address, including one's eventual mortality. Even before a medical diagnosis is made, individuals have experienced some unwanted changes in their lives. After the diagnosis is made, the prognosis often includes physical, mental, and other lifestyle changes that need to be anticipated and prepared for. For those who have heart disease, the underlying grief is the fact that the heart is no longer reliable. When the heart can no longer be depended upon to perform its function, it is a loss experience that needs to be grieved in order to reinvest in...

Loss of some aspect of self

We cannot experience a relationship loss without losing an integral part of and sense of who we are. If there was a relationship, we have invested some part of ourselves in it. Who we view ourselves to be comes from the feedback in the interactions dynamics of relationships. A major component of the grief process involves letting go of a former identity, grieving that part of you which is gone forever, and rebuilding a new identity. This loss of some aspect of self not only occurs in relationships with others, but also in any situation that demands change in personal identity. In addition to the above, loss of some aspect of self is also experienced in child abuse, rape, illness, physical change, loss of hopes, dreams, and major change and disappointments. Professional burnout and professional impairment are profound losses of self. Losses of aspects of self appear in various ways

Books for Professionals

Grief in Children A handbook for adults. Bristol, PA and London Jessica Kingsley. This is useful for teachers, counsellors, pastoral workers, parents, and others faced with the task of understanding children in grief and trying to help them. Fitzgerald, H. (2000). The Grieving Teen A guide for teenagers and their friends. This guide offers suggestions for developing grief support groups, and also gives directions for using the art process to help children (ages 6-12). Can be used individually or in groups dealing with loss and change. Curriculums are provided to use with four workbooks in the series 'When someone very special dies', 'When something terrible happens', 'When mom and dad separate', and 'When someone has a very serious illness'. children through trauma and grief. London Routledge. This is a sensitive reading to help professionals work with one who endures the impact of a simultaneous murder and parental loss. Trauma and confusion are compounded by...

The Cancer Counselling Center of Ohio

In the situation of life-threatening illness, anticipatory grief is compounded by uncertainty. At the Center, many clients have a disease which is potentially lethal. They face, as if this threat were not bad enough, the incursions and perhaps the worsening of bodily illness, the difficult treatments and their often debilitating side-effects, and the loss of many aspects of their customary daily life. The possibility of dying is just one facet of a much greater complex of issues. Treatment in these cases often calls for unique methods. We routinely use tools which can access the internal states - the subliminal message systems - that lie beneath the surface of conscious awareness. It is our belief that where denial, doubt, and ambivalence prevail, clearer messages can often be obtained from the 'inner self'. We begin with relaxation, brainwave biofeedback, or other calming techniques to create a disposition of openness. Then, mental imagery, searching for internal direction (i.e.,...

Acknowledgements

One cannot write a book that focuses on loss and grief without being reminded of what we have loved and appreciated the most in our lives. What has meant the most, upon reflection, has often been taken for granted. Writing this second edition has once again given me the opportunity to remember and appreciate my gifts of life. These gifts include my husband, children, and grandchildren. John, my husband of 40 years, has enriched my life in ways that would not have been possible without his encouragement and support. My children, whose adult friendships I now cherish, have validated my belief that life presents difficult challenges that can become opportunities of growth. And now my young grandchildren, symbols of new life and fresh energy, are reminders that despite the losses of those we love, we can and will love and live fully again. I would like to acknowledge the North Canton Medical Foundation and staff for the support they have provided for this second edition. Finally, I want...

Categories of Loss

Losses to understand the full significance of the present loss(es), and to anticipate secondary or symbolic losses that could occur as a result of the present loss. Rando (1993a) emphasizes the necessity to assess and address secondary and symbolic losses. She defines these losses as those which develop as a consequence following the first loss. This assessment is not meant to create an overwhelming situation for the bereaved individual who already feels out of control. The purpose is to help the counsellor more fully understand their present reactions and behaviours, and to gain a more accurate understanding of what this loss means to the bereaved, given a more detailed understanding of their past loss experiences. Moreover, by anticipating potential secondary losses, we can educate, prepare, and plan more effective intervention strategies for coping and grief resolution.

Developmental losses

Often developmental losses compound or confuse more visible losses. A 65-year-old whose job position is eliminated is also coping with developmental issues of aging and possible retirement. An adolescent being 'dumped' by a lover may also be experiencing losses inherent in that stage of development. A major loss during the adolescent period of development is to let go of carefree ways and to become responsible. And for children who lose significant others through death, the grief process may span their developmental stages. For children, at each new stage of development, the loss will be re-evaluated and new meaning will be integrated. Developmental losses can take many forms Life is loss, grief, growth A universal experience of cycles and circles Life is loss, grief, growth A universal experience of cycles and circles The categories of loss overlap. Figure 1.1 serves as a visual aid that allows the counsellor to educate the client about losses in life that might not have been...

Spiritual

The untimely death of a child, at any age, raises deep questions regarding the existence and the nature of a God that would allow this to occur. Karen had only one child, a 30-year-old son who had been killed in a head-on collision by an intoxicated driver shortly after Christmas. Prior to this he had served 10 years in prison, having been in the company of friends who had been arrested for breaking and entering. His friends managed to get away, and believing that one must be loyal to friends, he would not give their names. As a result he served the 10-year sentence alone. Karen and her husband had visited whenever they were allowed, and had lived for the day he would be released. At the time of his death, he had been home for 18 months. He had rebuilt his life, was employed as a land-scaper, and was planning on marriage within the next six months. Karen and her husband were overwhelmed with their grief and were experiencing a significant breach of faith. Counsellor Now I understand....

Psychological

This is a pivotal perspective that continues to emerge throughout the entire grief experience. Different aspects of this perspective will demand attention at varying times, often causing the client to feel drained of energy, unable to think or function. It will be important, early in the assessment, to listen for styles and characteristics of personalities and to assess both premorbid and present personalities of the clients. Ask the clients if they view themselves as being a different personality before the loss event. Use questions that encourage responses that provide information about clients in relationships with others and about their own sense of personal self-worth. Listen for responses that might indicate personalities that are dependent, histrionic, narcissistic, compulsive, and the like. A client's personality and how one views himself or herself are an important criterion in resolution of loss and grief. Assessment of the affective and cognitive domains is an ongoing part...

Sociologicalcultural

Societies and the cultures within them exert great influence over reactions to loss and ways in which their members experience grief. Multicultural issues may have to be the first issues to be addressed in an assessment in order to avoid placing the template of the dominant society over that of the client's. The culture that has shaped this client's identity and the culture that the client presently is living in provide a rich background for understanding this individual's unique and highly individualized grief experience. A client often feels torn between two worlds, and it is usually during a time when grief is the most acute that an individual will not feel that he or she belongs to either world. Funerals and rituals also need to be explored after a death-related loss. Questions that inquire about the type of funeral and the calling hours often provide important clues for further assessment. Some view calling hours and the funeral rite as strong sources of emotional support others...

Physical

Grief often manifests itself in physical symptoms. Understanding the potential that grief has in terms of interrupting one's normal existence, it is easy to comprehend the effect it might have on one's physical health and the disruption in the effectiveness of the immune system. It is not unusual for the bereaved to complain about chronic viral infections after a major loss (death or non-death) in their lives. Katy. I'm not exactly certain, but I feel that I should be over this and not feel this way 18 months later. I don't think it is my grief, I just think I didn't have enough time to get over one illness before I caught something else. I don't see this as having much to do with his death. He died in October. In November I decided to get laser surgery to stop smoking. By December I felt healthier than I ever have and could even breathe better. Then in January all these illnesses started. It just doesn't make sense. Counsellor. Are you aware that grief often manifests itself through...

Middle Sessions

During the middle parts of the counselling process, practitioners will hear reflections of continued pain and the torment of adjusting to and grieving an environment that is a poignant reminder of the loss. During the latter period of these middle sessions, there is some evidence of willingness and ability to accommodate to changed realities. Once past the acute phases, where more emotional support is necessary, bereaved individuals move into new realms that need exploration and intervention. Perspectives emerge and re-emerge, often centering on the psychological and sociological ones. Psychologically, the bereaved feel more in control of their emotions. They have begun to make new decisions and take small risks in an effort to rebuild their lives. With encouragement and guidance from the counsellor, coping efforts (Table 3.3, page 42) become more effective. Characteristics of resiliency assessed during earlier sessions can be incorporated into treatment strategies (Table 3.4, see...

Later Sessions

Later sessions do not declare that grief work has ended completely. There is no single right way to grieve and there is no set timetable for the specific experiences. There is some agreement in the field that at least two years is needed. However, even this time can vary, depending upon the loss and this does not mean that counselling is needed for two years. Some may only need one professional visit, but will, on their own, take a full two years to experience their grief and begin to rebuild their lives. The basic guideline for assessment and treatment is to be aware of potential problems associated with personalities, pre-morbid functioning, and complications after loss and also to reserve judgment on an individual's manner of grieving and the amount of time he or she takes to go through the process. A major part of these later sessions addresses the experience of letting go of former roles and identities and making new choices to initiate new life narratives. Reinvestment does not...

Basic Family Tasks

Although there is evidence of new norms in family configurations, these changes do not negate the belief that a family is expected to function as a basic social unit and provide fundamental necessities for its members, especially those who are not capable of meeting their own basic needs. Who the members are in this group and who should assume responsibility for specific tasks is not as important in today's definition of family. It is more important to adhere to a meaningful definition of 'family', similar to what was proposed in the beginning of this chapter. Thus it may be stated that, now and in the past, every culture prescribes basic tasks that are essential for every family to perform. When these tasks are not adequately performed, societies intervene. Duvall and Miller (1985) have outlined eight tasks expected by the American family. These tasks may be adapted to changing family norms and groups. Noteworthy among them are these four the provision of food, clothing, and shelter...

Death of a parent

Various other issues emerge depending upon one's age at the time of a parent's death. An example is a 20-year-old male whose father died of a heart attack at age 56. The grief reactions and fears of one's own mortality may become more acute when that son approaches his 56th birthday (anniversary reaction). When a parent dies during one's childhood or adolescence, one should keep in mind for these age groups that the loss of a parent must be understood according to the developmental level of the child or adolescent, and that these normal developmental tasks must be addressed. Moreover, this age group relies upon denial, repression, and suppression. Grief may not be fully addressed or resolved until early adulthood. Children and adolescents must grieve fully however, they must be allowed to do so on their timetables, and with ongoing, available support systems. With each stage of development, new questions and new issues will emerge that need to be re-examined and answered in light of...

Death of a sibling

When a sibling dies, the surviving sibling(s) experience a variety of thoughts and feelings. Often the survivor feels that the 'favorite' child has died, and that it is important to take on characteristics or behaviours of the deceased to lessen the grief of the parents. Role reversals (children assuming parental roles) occur also in attempts to alleviate parental pain. Guilt is a frequent emotion, as many siblings have harbored ill will towards each other over the years, and the reality of the death is difficult to adjust to. Many siblings have lost a close and trusted companion, and the grief will emerge during many milestones of their childhood and adult life. Davies (1990), in a seven-year longitudinal study of siblings who had died from cancer, found that siblings frequently thought of the deceased and grieved. Life had moved on however, thoughts and feelings were close at hand. For many adults whose siblings die, the current support systems may be unaware of the special bond...

Death of a child

No other loss has as many issues, and there is no other role that is governed by more rules or social sanctions. It is referred to as the one area in family life where society will step in and take over if the responsible adults do not perform according to certain dictates. Thus, when a child dies, the parents experience incredible guilt for a role in which they have not succeeded. There are differences in the ways males and females grieve, and when this is not understood, it may cause discord in the marital dyad. There may be problems parenting other children, and frequently one of the spouses closely resembles the deceased child, causing additional pain. This type of grief cannot be compared to any other type of loss, and counsellors should avoid trying to fit this grief into a current model for grief resolution. A common question following the death of a child is the concern over potential, future divorce. Many believe that statistics are high for divorce following the death of a...

Interventions

Members are matched in dyads based on information obtained during the pre-group intake. Attempts are made to match on perceived similarities of issues related to the loss, age, sex, or personalities. Each person interviews the other, discussing specifics of the loss, feelings then and now, and other areas of difficulty. About 20 to 30 minutes are allowed for this exchange. In the large group, members introduce their partners and the loss that they have experienced. This activity sets the tone for a non-threatening environment, recognizing the pain of grief and the possible difficulty involved in telling a group of strangers about the death. Moreover, it provides an initial opportunity to meet someone who is similar and begins the process of universality and cohesiveness.

Homework

Tell members that each week an assignment will be given. They are not forced to do this homework however, advise them that the more effort they put into these ten weeks and their willingness to take risks, the more they will get from the experience. Explain that the homework is designed to promote thought and reflection on the session just experienced, and also to prepare them for the topic of the next week's session. Explain that grief work is painful and difficult. It is normal upon leaving a session to experience a surge of pain. This will diminish over time, and Others' grief should be left at the meeting, not taken home each person has enough of his her own. the early sessions are the most difficult. Invite and encourage members to call you in between the sessions if extra support is needed. Caution them that they should not be alone in their grief.

Session 6 Stress

Stress is a normal part of everyday life. Loss and grief bring additional stress. Often it is difficult to sort out and identify specific stressors. Some may only have a vague idea that they are 'stressed out'. Within the group it is helpful to identify specific stressors, when they occur, how often, how they have been dealt with, and specific ways for healthier ways of coping. The goal of managing stress is to change the problem that caused the stress and to regulate the distressful emotions caused by the problem (Lazarus and Folkman, 1984). It is not possible to change the problem that caused the stress (death of a loved one) however, it is possible to change some of the concurrent stress that is contributing to the grief experience.

Family interventions

What is the state of the parent's chronosystem What aspects of it will positively and negatively impact on the parent's grieving process and his or her ability to help their child grieve 11. Does the child have risk factors for grief with complications 13. What is the state of the child's chronosystem What aspects of it will positively and negatively impact on his or her grieving process Conversely, if deficiencies in the parent or the environment exist or the child possesses risk factors as outlined by Table 6.1 or 'red flags' as listed in Table 6.2 are present, then an intervention may be necessary. Though each intervention must be tailored to the needs of an individual child and family, there are several general aspects that can be incorporated. One point is that the parent's primary role is to support and educate the child. Often, this requires an intervention to augment the parent's coping skills. Similarly, an intervention by a grief counsellor, teacher, or doctor often needs to...

School interventions

A school's commitment to building resilient children must be maintained in times of crisis. When a child experiences a death, the school should have an action plan that supports or enhances resiliency while encouraging healthy expressions of grief. To ensure this, Rowling (2003) states that a school needs to have a proactive approach to bereavement interventions. A school's health education curriculum should include discussions about death and bereavement so that the teachers and students develop an open dialogue prior to a child experiencing a loss. This then allows for a more natural conversation between staff and students following a death. Additionally, a school should develop a bereavement action plan prior to a death. Adults should be pre-selected and educated on grief and resiliency so that they are emotionally and cognitively prepared. They should learn how to discuss bereavement in developmentally appropriate terms and practice talking about death before one occurs, again to...

Winstons Wish

Winston's Wish is a 'community based child bereavement service' based in Gloucestershire, England that strives to support grieving children through prevention (Stokes, 2004 15-16). They recognize that bereaved children are at risk if they lack the resiliency tools and the adequate social support to weather their grief throughout their development. Through its myriad of services, Winston's Wish seeks to support and educate bereaved children and their families who are at risk to prevent grief with complications. Understanding and expressing grief. With these goals and interventions, Winston's Wish embodies the ideas discussed in grief with healthy responses, including the sense of continuing to remember those who are gone, normalizing the experience, and continuing the bond with the loved one. Similarly, Winston's Wish represents a functional model of intervention to prevent grief with complications. It is a microsystem supported by the child's macrosystem that utilizes resiliency and a...

Summary

Through Camp Lost and Found and its follow-up, the children learned how to grieve and go on living. The program, like Winston's Wish, utilized a working knowledge of how children comprehend death and their unique challenges when grieving to create an age-appropriate microsystem that taught the tools for self-empowerment, resiliency, and effective coping skills. Through this, Camp Lost and Found fostered resilient children that have the capability to face the difficult emotions of grief while also living rewarding, full lives. A living example of this is Frank Frank was 11 when he participated in Camp Lost and Found. His father had been diagnosed with an incurable illness, but withheld the information from his children. He also chose not to undergo treatment instead he received palliative care. After his father's death, Frank's mother sought support from The Center for Grief Counselling and Education. She was concerned that his father's reticence during his illness At the beginning of...

Special Issues

Every loss has special features, and for each individual experiencing a loss, there are unique issues. While this chapter cannot address the numerous issues or the variety of hardships that must be endured after every loss, it will focus on certain special losses wherein resolution of grief can be more difficult. Included will be trauma in general, murder, suicide, AIDS, and perinatal neonatal loss. Inherent in these types of loss is the concept of disenfranchised grief. Disenfranchised grief, as defined by Doka, is the 'grief that persons experience when they incur a loss that is not or can not be openly acknowledged, publicly mourned, or socially supported' (1989 4). He has proposed three possible reasons for this occurrence the relationship is not recognized the loss is not recognized or the griever is not recognized. This type of grief is often more intense because of situations surrounding the loss. Moreover, these situations frequently cut off sources of needed emotional...

Trauma

Concerns of future terrorism and fear of violence have led to, and will continue to incur, more violence. Although the purpose now and in the future will be to defeat violent extremism, protect the innocent, and help countries rebuild, history shows little evidence that these goals can be achieved. These attempts often have only resulted in more losses loss of lives, loss of hope for peaceful solutions, and loss of confidence in national leaders. Changes in values and belief systems challenge individuals' and nations' assumptive world, and this is an integral part of the grief process. Losses must be addressed on all levels and across all perspectives.

Other Losses

There are other unique, difficult, or horrendous losses that many are forced to cope with, resolve, and find reasons to reinvest in life again. There are losses that many are forced to live with that can make death appear to be the better alternative. These include floods and other natural disasters, fire, industrial injuries, chronic illnesses, job loss, rape, assault, robbery, random violence, forced relocation, and other circumstances in which loss and grief are key components. These examples have been intended to raise an awareness that different losses may appear similar yet at the same time raise unique issues. This awareness is intended to remind the practitioner of the need to explore all areas of a client's loss, and build interventions to meet the idiosyncrasies of each case.

Chronic mourning

Chronic mourning is another category of potential concern for healthy grief resolution. This type of grief never seems to cease, as, for example, the client who continues to display signs of acute grief years beyond the loss. Counsellors who have assessed this syndrome are struck by the intensity of the grief, and state that the grief appeared to be so acute and fresh that they would have expected the loss to have just recently occurred. Moreover, there has never been a hiatus in the emotions. That is, there was never a period in which the bereaved experienced some relief from pain or some return to equilibrium. Bowlby (1980), Parkes and Weiss (1983), Raphael (1983), Rynearson (1990), and Rando (1993) have offered valuable contributions to this concept.

New Perspectives

Since the first edition of this book, there have been different theories proposed that challenge prior concepts of pathology and grief resolution. The new models discussed in Chapter 1 have suggested a need for different perspectives and language when considering the bereavement process. Continuing bonds, meaning reconstruction, and the dual process model all propose less emphasis on syndromes of grieving and more attention to an accommodation of changing realities. Addressing the need to revise assumptive worlds and to restore a sense of coherence to life narratives is thought to be an important area of focus when working with bereaved individuals (Neimeyer, 2001). Moreover, these models do not presume that the bereaved must withdraw psychic energy from the deceased. They challenge former definitions of pathological grief that emphasized an inability to sever ties. Newer constructs propose that healthy grieving includes continued symbolic bonds with the deceased (Neimeyer, 2001). The...

Websites

Www.childrensgrief.net offers information that is useful in helping children deal with grief. Grief therapist and educator, Linda Goldman, manages this site. www.compassionatefriends.com site whose mission is to assist families toward the positive resolution of grief following the death of a child and to provide information to help others be supportive. www.healingheart.net dedicated to providing grief support and services to parents whose child has died - includes information on sibling grief, parent and grandparent grief, and a section on infant loss. www.grievingchild.org site sponsored by the Dougy Center for Grieving Children - includes sections for children and adults who have experienced the death of someone close to them. chart that discusses developmental considerations concerning children's grief, including their developmental stage, concept of death, grief response, signs of distress, and possible interventions.

Organizations

American Academy of Grief Counselors, American Institute for Health Care Professionals, 2400 Niles-Cortland Rd SE, Suite 3, Warren, OH 44484, USA. Tel (330) 652-7776 www.aihcp.org aagc.htm. Offers certification and fellowship programs for professionals who practice grief counselling. Marietta, GA 30067, USA. Tel (800) 232-SIDS (7437) www.sids.org. Offers support and crisis counselling to persons who have lost a child to SIDS. Also provides grief literature and referral information. International network. Support by and for parents who have experienced the death of one or more of their children during a multiple pregnancy, at birth, or in infancy or childhood. Telephone support, information on the grieving process, monthly chapter meetings. National newsletter and sibling newsletter. Chapter leader's manual. Resource library. International organization with 4,000 affiliated groups. Establishes peer support groups in churches, schools or social agencies for children and adults who are...

Symbolic interaction

Symbolic interaction was the first theoretical construct utilized by Nadeau in her research that investigated the process by which grieving families constructed meanings and the nature of those meanings. In her 1998 research she studied patterns of ten non-clinical, multigenerational families. Her thoughts guiding the research were that we know very little about the manner in which families construct meanings. Most of what we know comes from an individual's perspective. Yet individuals don't grieve in isolation. Grief is a family affair.

Camp Lost and Found

In Canton, Ohio, The Grief Support and Education Center had similar goals when it designed Camp Lost and Found. Camp Lost and Found was a day camp for children and adolescents who had lost a loved one. Its mission was to create a sense of normalcy for bereaved children while they learned to experience grief safely and gain the necessary resiliency tools to continue their grief work throughout their development. The goals of the camp (Table 6.5) all reflected its mission statement. Demystifying death and grief. Teaching how to experience and control emotions associated with grief. Giving children a sense of empowerment and control so they can utilize their skills of resiliency while grieving and having fun. Camp Lost and Found was comprised of two programs, one for school-age children and one for adolescents. Each camp was five days in duration and occurred at a local college where the participants had access to both the classrooms and the outdoors. The staff consisted of a grief...

Philosophical

Additional assessment questions concerning this perspective will be generated by clients' responses to the counsellor's initial queries. Concepts from Neimeyer's meaning reconstruction and the use of the clients' personal narratives can be utilized at this entry point of an assessment. Early in the experience of grief, the bereaved are more aware of a sense of emptiness and meaninglessness. They do not feel connected to others, nor do they want to be. There is an overwhelming sense of being alone in their grief and a belief that no one could truly understand or feel their pain. They do not want to be told that they are similar to anyone else who has experienced a similar loss. There is a true sense of being in an existential crisis, totally disconnected from others. It is not the counsellor's role at this time to try to lift grievers from the depths of their despair rather it is important to assess the meaning of their existential crisis and encourage their...

Constructivism

Lastly, principles from constructivism add insight and offer practical applications to family therapy. This theory has had a variety of interpretations, many of which have been controversial. One of the basic premises of this theory is that reality does not exist as a singular entity, but that there is more than one reality. This concept is a core principle of postmodern thinking. Within family therapy this philosophy has been used to facilitate a different way of assessing and conceptualizing family issues. Counsellors have become more aware of the fact that they were viewing right and wrong and good and bad based on their own values. Previously, professionals in the helping professions imposed their meanings of reality upon a client, especially upon a family. Constructivism asks these professionals 'not to consider what they are seeing in families as existing in the family but, instead, understand what they are seeing is the product of their particular set of assumptions about...

Definitions

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) defines unresolved grief in terms of symptoms that can be identified as not being characteristic of a normal grief response. Moreover, these bereavement symptoms can be differentiated from symptoms of a major depression. The symptoms of unresolved grief include Horowitz et al. used the terms 'pathological grief' and 'mourning' to describe problems in grief resolution Pathological grief is the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behaviour, or remains interminably in the state of grief without progression of the mourning process toward completion. Pathological mourning involves processes that do not move progressively toward assimilation or accommodation but, instead, lead to stereotyped repetitions or extensive interruptions of healing. (1980 1157) Brayer (1977) used the term 'pathological grief' and defined it in relation...

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