Day Two: Good Grief

In preparation for my second day of training, the manager of my clinical training program sent two articles via email: Models of Coping with Bereavement: A Review by Margaret S. Stroebe and Henk Schut and Good Grief by Meghan O'Rourke.

Picture Info

On the second day of training, I learned the differences between loss, grief, mourning, and bereavement.

• A loss is a condition of being deprived of something or someone. There are primary losses and secondary losses. The primary loss is the death and the secondary losses are those that impact the lives of the surviving members (e.g. emotional, financial, social, family structure, school, lifestyle, work).
As a counselor, interventions to use include a family mobile, loss impact worksheet, and
loss integration worksheet.

• Grief is an inward, individualized and normal response to a loss.
Grief is behavioral, cognitive/mental, emotional, physical, social, and spiritual/existential. 

 Picture Info

Types of Grief:

Anniversary is prompted by a holiday or anniversary of the death.

Inhibited is a type of grief in which the focus is on the positive or negative of the deceased. The client is remembering the deceased as being all positive or all negative – “putting someone on a pedestal.”

Abbreviated grief is an insufficient attachment or minimal reaction/ambivalent.

Disenfranchised grief occurs when the loss cannot be acknowledged publicly. Sometimes there is a lack of social support or intolerance because of circumstances such as alcoholism, dementia, miscarriage, abortion, affair, homosexual relationships, and adoption.

Complicated grief is a form of grief in which the common reactions become extreme. This type of grief requires assessing the severity, duration, and functioning of the client. A client may say something like, "I'm stuck." 

Recognizing Complicated Grief:
1. Unable to talk about loss
2. Intense grief reaction
3. Theme of loss – experiencing several losses at one time (i.e., kicked out of house, mom died, brother moved to NY, lost job)
4. Preserves the environment: bedroom intact, alter becomes extreme
5. Physical symptoms
6. Radical social changes
7. Depression or false euphoria
8. Imitation of deceased
9. Self-destructive behaviors such as gambling, sexual, substance, and cutting
10. Unaccountable sadness
11. Phobias about illness
12. Avoidance of rituals

Complicated Grief IS NOT (Time sensitive Diagnosis):

• Post Traumatic Stress Disorder

• Major Depressive Disorder

• Dysthymic Disorder

• Generalized Anxiety Disorder

• *Adjustment Disorder – can not be used as a diagnosis when death is present

• Acute Stress Disorder

Characteristics that are NOT normal for grief:
• Guilt other than actions at the time of death
• Thoughts of death other than “better off dead” or wanting to be with deceased (i.e. making a plan or taking action)
• Morbid preoccupation with worthlessness
• Marked psychomotor retardation
• Prolonged and marked functional impairment
• Hallucinatory experiences (not with deceased)

                           Mourning is the normal and natural act of grieving. It is an outward, private and public expression of a loss.

 

Picture Info

Mediators of Mourning:
1. The relationship – who the person was that died
2. The nature of the attachment – secure, anxious, ambivalent
3. Mode of death – Natural, Accidental, Suicide, Homicide (NASH)
4. Historical antecedents – multiple losses, type of death, history of mental illness, coping
5. Personality variables – anxious, dependent, narcissistic, bipolar, borderline, enmeshed
6. Social variables – support system and support group
7. Concurrent stressors – example: giving up job
In working with clients, mourning can be expressed through creating a memory box, journaling, writing a letter to the person who died, and prayer.

• Bereavement is a life event occurring over a period of time that includes adjusting to a loss.