Grief counseling

:"For the episode of The Office see Grief Counseling (The Office episode)."

Loss and grief are inevitable at some time in everyone's life [Corr, Charles A. "Children, Adolescents, and Death: Myths, Realities and Challenges." Death Studies 23 (1999): 443–463] and at any age [Wolfe, Ben, and Linda Senta. "Interventions with Bereaved Children Nine to Thirteen Years of Age: From a Medical Center-Based Young Person's Grief Support Program." In David W. Adams and Eleanor J. Deveau eds., Beyond the Innocence of Childhood: Helping Children and Adolescents Cope with Death and Bereavement, Vol. 3: Beyond the Innocence of Childhood. Amityville, NY: Baywood, 1995] . From pets to close friends and family, from moving countries to changing schools, by death of a loved one or after community disaster. It is present getting married (no longer single) and in divorce (no longer married). The more significant the loss, the more intense the grief is likely to be.

Everyone experiences and expresses grief in their own way, often shaped by how their culture honors the process or not. It is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. One can expect a wide range of emotion and behavior. In all places and cultures, the grieving person benefits from the support of others [Nadeau, Janice Winchester. Families Making Sense of Death. Thousand Oaks, CA: Sage, 1998] . Where that is lacking, counseling may provide an avenue for healthy resolution. Similarly, where the process of grieving is interrupted for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, it can remain unresolved and later resurface as an issue for counseling.

Counseling

Grief counseling becomes necessary when a person is so disabled by their grief, overwhelmed by loss to the extent that their normal coping processes are disabled or shut down [Neimeyer, Robert. Lessons of Loss: A Guide to Coping. New York: McGraw-Hill, 1998] . Grief counseling facilitates: expression of emotion and thought about the loss, including sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness. It includes thinking creatively about the challenges that follow loss, and coping with concurrent changes in their lives. Often people feel disorganized, tired, have trouble concentrating, sleep poorly and have vivid dreams, change in appetite. These too are addressed in counseling.

Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that occurred in the distant or recent past that have overwhelmed a person's coping ability There are considerable resources on line covering grief or loss counseling such as the Grief Counseling Resource Guide from the New York State Office of Mental Health [http://www.omh.state.ny.us/omhweb/grief/GriefCounselingResourceGuide.pdf] .

Grief counseling may be called upon when a person suffers anticipatory grief, for example an intrusive and frequent worry about a loved one's whose death is neither imminent nor likely. Anticipatory mourning also occurs when a loved one has a terminal illness. This can handicap that person's ability to stay present whilst simultaneously holding onto, letting go of, and drawing closer to the dying relative [Rando, Therese A. Clinical Dimensions of Anticipatory Mourning. Champaign, IL: Research Press, 2000] .

In March of 2007, grief counseling and grief therapy were placed on a list of treatments that have the potential to cause harm in clients in the APS journal, "Perspectives on Psychological Science". [Lilienfeld, S. O. (2007). Psychological treatments that cause harm. "Perspectives on Psychological Science", "2", 53-70.] In particular, individuals experiencing "relatively normal bereavement reactions" may experience worse outcomes after receiving grief counseling.

Grief therapy

There is a distinction between grief counseling and grief therapy. Counseling involves helping people move through uncomplicated, or normal, grief to health and resolution. Grief therapy involves the use of clinical tools for traumatic or complicated grief reactions [Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. "Diagnostic Criteria for Traumatic Grief." Death Studies 24 (2000):185–199] . This could occur where the grief reaction is prolonged or manifests itself through some bodily or behavioral symptom, or by a grief response outside the range of cultural or psychiatrically defined normality [Worden, J. William. Grief Counseling and Grief Therapy, 2nd edition. New York: Springer, 1991] .

Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions, [Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. "Diagnostic Criteria for Traumatic Grief." Death Studies 24 (2000):185–199 ] , which are usually brought on by the loss of a close person (by separation or death) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence. They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy. A common area where grief therapy has been extensively applied is with the parents of cancer patients.

Controversies

Efficacy and Iatrogenesis

At present (as of 2008), a controversy exists in the scholarly literature regarding grief therapy's relative efficacy and the possible harm from it (iatrogenesis). Researchers have suggested that people may resort to receiving grief therapy in the absence of complicated (or abnormal) grief reactions and that, in such cases, grief therapy may cause a normal bereavement response to turn pathological. [Neimeyer, R.A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.] Others have argued that grief therapy is highly effective for people who suffer from unusually prolonged and complicated responses to bereavement. [Larson, D.G., & Hoyt, W.T. (2007). What has become of grief counseling? En evaluation of the empirical foundations of the new pessimism. Professional Psychology: Research and Practice, 38(4), 347–355.]

In March of 2007, grief counseling and grief therapy were placed on a list of treatments that have the potential to cause harm in clients in the APS journal, "Perspectives on Psychological Science". [Lilienfeld, S. O. (2007). Psychological treatments that cause harm. "Perspectives on Psychological Science", "2", 53-70.] In particular, individuals experiencing "relatively normal bereavement reactions" may experience worse outcomes after receiving grief counseling.

Validity of "Complicated Grief"

Does "complicated grief" exist in the absence of such mental disorders as depression, posttraumatic stress disorder, and personality disorders? Bereavement counselors and grief therapists often claim, on the basis of theory, that the psychological suffering of individuals who have experienced a significant loss can be attributed to "complicated grief." However, to date (as of 2008), empirical studies have not yet convincingly addressed the question regarding the incremental validity of the theoretical notion of complicated grief. In other words, scientists have not yet presented convincing data that complicated grief is a syndrome that exists as separate from other mental health problems. [ Bonanno, G.A. (2006). Is Complicated Grief a Valid Construct? Clinical Psychology: Science and Practice 13 (2) , 129–134 ] New research on this topic is likely to appear in the scientific literature in the recent future.

Grief and trauma counseling

Anticipating the impact of loss or trauma (to the extent than any one can), and during and after the events of loss or trauma, each person has unique emotional experiences and ways of coping, of grieving and of reacting or not. Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster both the cost and sometimes the supports are greater. Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon. These are particularly challenging times for children [Kathleen Nader, K 'Understanding and Assessing Trauma in Children and Adolescents Measures, Methods, and Youth in Context' Routledge 2007] who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community. Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary [The Road to Resilience, APA Pamphlet http://www.ndsu.edu/counseling/the_road_to_resilience.pdf] . The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed.

This article addresses counseling with complex grief and trauma [Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. "Diagnostic Criteria for Traumatic Grief." Death Studies 24 (2000):185–199] , not only Complex post-traumatic stress disorder but those conditions of traumatic loss and psychological trauma that for a number of reasons are enduring or disabling. For example, where an adult is periodically immobilised by unwelcome and intrusive recall of the sudden and violent death [Rynearson E.K, Editor 'Resilience and Intervention Beyond the Crisis' Routledge 2006] of a parent in their childhood. One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.

The post-trauma self

Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the self, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques to best fit the presentation of the problem. Disruption in the previously supportive bonds of attachment and of the person's ability to manage their own affects challenges traditional, so called 'non-directive' client centered counseling approaches. One example of this paradigm shift in approaches is the Multitheoretical Psychotherapy of Jeff Brooks-Harris [Brooks-Harris, J. E. (2008). Integrative Multitheoretical Psychotherapy. Boston: Houghton-Mifflin] .

The post-traumatic self may not be the same person as before [Wilson J.P, 'The Posttraumatic Self Restoring Meaning and Wholeness to Personality' Routledgte 2005] . This can be the source of shame, secondary shocks after the event and of grief for the lost unaltered self, which impacts on family and work [Wislon, J.P, 'Posttraumatic Shame and Guilt' Trauma, Violence, & Abuse', Vol. 7, No. 2, 122-141 (2006) DOI: 10.1177/1524838005285914 2006 SAGE Publications ] . Counseling in these circumstances is designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach [Julian D. Ford, Christine A. Courtois, Kathy Steele, Onno van der Hart, Ellert R. S. Nijenhuis 'Treatment of complex posttraumatic self-dysregulation' Journal of Traumatic Stress Volume 18, Issue 5 , Pages 437 - 447] [PAUL A FREWEN, RUTH A LANIUS () 'Toward a Psychobiology of Posttraumatic Self-Dysregulation. Reexperiencing, Hyperarousal, Dissociation, and Emotional Numbing' Annals of the New York Academy of Sciences 1071 (1), 110–124. doi:10.1196/annals.1364.010 (2006)] .

See also

* Grief
* Grief therapy dog
* List of counseling topics

References

ources

*Hammerschlag, Carl A. The Dancing Healers. San Francisco: Harper San Francisco, 1988.
*Hogan, Nancy S., Daryl B. Greenfield, and Lee A. Schmidt. "Development and Validation of the Hogan Grief Reaction Checklist." Death Studies 25 (2000):1–32.
*Rubin, Simon Shimshon. "The Two-Track Model of Bereavement: Overview, Retrospect, and Prospect." Death Studies 23 (1999):681–714.
*Sofka, Carla J. "Social Support 'Internetworks,' Caskets for Sale, and More: Thanatology and the Information Superhighway." Death Studies 21 (1997):553–574.
*Staudacher, Carol. A Time to Grieve: Mediations for Healing after the Death of a Loved One. San Francisco: Harper San Francisco, 1994.
*Stroebe, Margaret, and Henk Schut. "The Dual Process Model of Coping with Bereavement: Rationale and Description." Death Studies 23 (1999):197–224.
*Wolfe, Ben, and John R. Jordan. "Ramblings from the Trenches: A Clinical Perspective on Thanatological Research." Death Studies 24 (2000):569–584.