Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.


Personal Loss: Bereavement and Grief

Crisis Intervention Strategies by Richard K. James Chapter Eleven

Sandra Mistretta

on 2 December 2013

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Personal Loss: Bereavement and Grief

Personal Loss:Bereavement and Grief
How Do Crisis Workers Help ?
Dynamics of Bereavement
Conceptual Approaches to Bereavement
Types of Loss
Intervention Strategies
Do No Harm
Cultural Dynamics

Five-Stage Grief Model developed by Elisabeth Kubler-Ross in 1969
It is the most popular Grief Model
Can be applied to the terminally ill patient or to someone experiencing bereavement
Often does not follow the stages in order, some people skip a stage
This is NOT a counseling model

Newly Divorced or Seperated
Individual counseling—
Asses for levels of grief, guilt, and stress
Brainstorm ways to commemorate pet’s life and how they will transform this loss into growth
With children, play therapy and ceremonial events may be employed, as well as displaying symbolic objects that remind the child of the pet, and link child to the pet
Family Therapy—
Allow the family to talk about pet’s death in an honest and factual way
Brainstorm with family on ways to commemorate pet’s life and how they will transform this loss into growth
Individual counseling—
Asses for levels of grief, guilt, and stress
Brainstorm ways to commemorate pet’s life and how they will transform this loss into growth
With children, play therapy and ceremonial events may be employed, as well as displaying symbolic objects that remind the child of the pet, and link child to the pet
Family Therapy—
Allow the family to talk about pet’s death in an honest and factual way
Brainstorm with family on ways to commemorate pet’s life and how they will transform this loss into growth

an objective state or condition of deprivation that is especially caused by death and is then followed by grief...
A psychic state or condition of mental anguish or emotional suffering AND a result OR anticipation of the bereavement
a social or cultural state or condition expressing the grief or feeling because of the bereavement
Sociocultural Mores
Rando (1984) states "For all societies there seem to be three general patterns of response: death accepting, death defying, or death denying."
Death Defying

Death-defying--refusal to believe that death would take anything away and believe it could be overcome.

Example: early Egyptians who built pyramids for the Pharaoh which encluded their wives, money, and possessions for the world after death with the expectation that the Pharaoh could vanquish death.

Death Accepting
Viewing death as an inevitable and natural part of the life cycle. Behaviors and events of the dying process are integrated into everyday life.

Example: primitive, non-technological societies such as the Fiji Islanders, where rituals and interactions include casual, comfortable discussions of death.

Death Denying
A refusal to confront death, belief that death is antithetical to living and that it is not a natural part of human existence.

Example: United States, where there are few rituals associated with grieving. Rituals are generally replaced by contrivances for coping with grief.

Does the institutionalization and social organization of grief impose social uniformity
on previously diverse patterns of grief and bereavement?
p. 364
Developed by John Schneider in 1984
Eight-stage model, which he calls, “Process of Grieving.”
A holistic, growth-oriented model that integrates physical, cognitive, emotional, behavioral, and spiritual responses to loss.
Schneider Model: The Transformational Stages of Grief

Attitudes towards, life, death, and dying have shifted tremendously in the past 100 years in Western society.
Age specific morality patterns
Institutionalized Death
Institutionalized Grief
Rural Orientation to More Urban Orientation
Stages 1 and 2
Stage 1– The Initial Awareness of Loss
Initial awareness of threat to physical, cognitive, behavioral, emotional, and spiritual dimensions.
Common feelings: shock, numbness, confusion, detachment

Stage 2– Attempts at Limiting Awareness by Holding On
Focusing thoughts and energy on positive aspects of the loss. During this time the person will try to use coping strategies that have worked with past losses.
Common feelings: tension, muscular tension, sleep deprivation, bargaining, guilt
Stage 3 and 4
Stage 3-- Attempts at Limiting Awareness by Letting Go
Recognizing one’s personal limits with the loss, gaining independence from the lost person or object.
Common feelings: depression, rejection, shame, anxiety, cynicism

Stage 4– Awareness of the Extent of the Loss
The most easily recognized stage of mourning in which the bereaved feels lonely, helpless, and hopeless.
Common feelings: Exhaustion, pain, silence, aloneness, preoccupation, sadness, loneliness
Stage 5 and 6
Stage 5– Gaining Perspective on the Loss
The place of accepting what has happened. Understanding how the bereaved has grown as well as understanding what has been lost.
Common feelings/behaviors: patience, solitude, acceptance, forgiveness, openness, healing, and peace.

Stage 6– Resolving the Loss
The bereaved can resume activities unconnected with the loss, without this being an act of holding on to the loss or letting go of the loss.
This is a time of finishing business and saying good-bye
Common characteristics: self-care, relinquishing, forgiveness of self and others, determination, and peacefulness
Stage 7 and 8
Stage 7– Reformulating Loss in a Context of Growth
This phase focuses on personal growth by reminding people of their “strengths and limits, mortality, and the finiteness of the time they have.” (Schneider, p. 226)
Common behaviors: enhanced sensory awareness, spontaneity, patience, integrity/balance/centeredness, increased tolerance for pain

Stage 8– Transforming Loss into New Levels of Attachment
The integration of the physical, emotional, cognitive, behavioral, and spiritual aspects of a person to gain higher understanding and acceptance of the loss.
Common reactions: awareness of interrelationships, unconditional love, creativity, wholeness, deep empathy, end of searching, and commitment
A counterpoint to Traditional Models
The Dutro Model
Developed in 1994 this model views grief and loss from a more individual perspective and takes into account the individual experiences with loss, the mode of death, relationship to the departed, the cultural norms.
Refutes “stages” of grief and denounces the belief that loss of sadness or display of grief is pathological
Death of a Spouse
Death of a Child
Bereavement in Childhood
Bereavement in Adolescence
Bereavement in Elderly People
Job Loss
Separation and Divorce
Death of a Pet

Death of a Spouse
One of the most emotionally stressful and disruptive events in life
More widows (women) than widowers (men)
Bereaved spouse faces a number of problems and grief stages alone
Surviving spouse can even face serious personal, emotional, economic, social, career, family, and community problems.
Death of a Child
The death of a child is always a major loss.
Every parent suffers the loss somewhat differently, and so is unique in terms of needs, history, coping styles, relationship to others, social concerns, family situation, and overall sense of meaning regarding the death.
Whether the death is a stillbirth, SIDS, an accidental death or ilness in childhood or adolescence, or if older parents lose an adult child, the traumatic effects are the same.
"Our children are in our blood;
the bond with them
does not seem to break, and the parents find subtle yet unconscious ways of preserving that bond."

The older the child, the more initial awareness they will have, but for the younger child, grief and bereavement might be delayed.
The tragedy is all too common in the US, where 3.4% of children under 18 will the loss of one or both parents, according to an analysis of the 2001 US Bureau of Census (Dopp & Cain, 2012).
The process of childhood grief is often misunderstood and, on a societal level, wrought with myth.
It is not uncommon for a family to experience the loss of a home, family income, health insurance, and become overwhelmed by the red tape of the deceased’s estate. All of these things can delay the normal process of healthy grief and bereavement in a child and family, and can even lead to Childhood Traumatic Grief (CTG) (Auman, 2007).
Bereavement in Childhood
Adolescent Grief
Often the adolescent may feel excluded from the family's grief, but there is a great need to included.

They may not know how to behave because they do not have a sufficient understanding of the death, the circumstances surrounding the death, or the proper family/sociocultural mourning rituals.

They need opportunities to be included in discussions, planning, mourning, and funeral and commemorative activities.

The danger of a teen's complex reactions is that death brings a stark reality to an already cynical teenager who may act out his or her anger and depression in dangerous, life threatening ways.
Bereavement in Elderly
From a developmental standpoint, bereavement in the elderly is compounded by decreases in sensory acuity, general decline in health, and reduced mobility.
Elderly people generally experience more loss than do their younger counterparts: loss of relatives and friends; loss of job, status, and money; loss of bodily functions and abilities; and loss of independence and self-respect.
An advance in age tends to correlate with a decrease in coping strategies
Shoenburg's Conclusions
1. Elderly people present more somatic problems than psychological problems.

2. There is no indication that the intensity of grief varies significantly with age of the elderly person.

3. Evidence suggests that grief among older people may be more prolonged than among younger people.

4. Elderly people tend to be lonelier and to have far longer periods of loneliness than do their younger counterparts.
Crase (1994) found that the ways the older generation
generally deals with loss fall into the following
three broad categories.
One group totally ignores the
inevitability of death and makes no
preparation for it. People—especially men—
in this category engage in little or no open discussion of death. By ignoring death issues,
these elderly individuals attempt to avoid negative
feelings, using denial as a defense mechanism.
They are vulnerable to being unprepared when
struck by disabling disease, crisis, disaster,
or the death of their spouse.
A second group thinks
about death and dying excessively
and makes unusual preparations
for death’s inevitability. These
individuals go overboard in making
meticulous plans for every detail of
their decline, death, and funeral.
A third group demonstrates
a more healthy balance. They are
attuned to the developmental
implications of total loss, making
appropriate plans and decisions, and
going on with their normal lives.
AIDS has become a worldwide pandemic since the 1980s, and is something every therapist should be prepared to deal with.
An individual who has AIDS may feel a range of emotions including stigmatization, personal rejection, prejudice, religious rejection, job loss, economic deprivation, discrimination, legal oppression, fear of contagion, guilt, shame, and loss of self-esteem.
When an individual is first diagnosed with HIV, he or she will often feel a sense of disorientation, anxiety, depression, self-blame, shock, denial, and demoralization.
Following a diagnosis, an individual often withdraws from society due to feelings of stigmatization, marginalization, social, occupational, domestic, and sexual hostility, abandonment, and isolation. (Nord, 1997, pp. 43-64)

AIDS: A Modern Dilemma
When losing a job, the person is also losing a large part of their identity, their earnings, social interaction, and daily structure.

Systemic effect on family
Systemic effect on entire towns and industries
The person who has lost his/her job may experience: depression, anger, blame, loss of self-esteem, and loss of self-control.
Intervention Strategies

Lethality assessment may be in order
Career Counseling
Devastating to a family system
Children feel confused, insecure, fearful, trapped, angry
Adults feel fearful, depressed, and emotional turmoil
If the separation is sudden or unexpected, the spouse may feel shock, numbness, disbelief, denial, and anger
Ultimately leading to feelings of frustration, failure, loss, and mourning
Divorce and Separation
The bond between pet and its owner is recognized as an integral part of the owner’s life (Reitmeyer, 2000)
When a pet dies the owner may feel similar reactions as if experiencing the death of a human family member.
Can be especially acute for the elderly
Commonly a child’s first experience with loss is with a family pet
Death of a Pet
Different Kinds of Grief
Complicated Grief & Mourning Reaction
ccurs when a person is not able to mourn a loss
(Middleton et al., 1998) (Raphael &Minkov, 1999)

Indicators of complicated grief are:
Continuous distressed yearnings
Pangs of severe separation anxiety
Intense intrusive thoughts
Feelings of increased aloneness and emptiness
Excessive avoidance of tasks related to the deceased
Loss of interest in personal activities
Disturbances in sleeping, eating, and other daily living patterns (Horowitz et al., 1997)
Disenfranchised Grief
“When a person has experienced a deep and meaningful attachment, experienced loss, and cannot openly acknowledge or grieve the loss or have it validated by others, the grief becomes disenfranchised.”
(Doka, 1989)
May occur in many situations:
Homosexual partners who have not come out to others
Individuals having affairs
Men and women experiencing a miscarriage
(James, 2008)

When working with individuals experiencing disenfranchised grief, it is important to be very empathetic, and develop a therapeutic alliance with the clients as they share their grief openly, often for the first time.
(James, 2008)
Traumatic Death
The traumatic death of a loved one greatly increases the mourner’s likelihood of developing complicated grief.
Several factors increase this risk:
The fact that the death was unexpected and therefore the mourner was not prepared for what was going to take place
Witnessing the death and the events leading up to it
The presence of blood or mutilation
(Rando, 1996)
Traumatic death may lead to PTSD among the mourners (James, 2008)
Individual Counseling–
Assess lethality
Assess coping skills and resources
Assess support system
Rational-emotive behavior therapy and behavioral modalities
help client identify self-defeating beliefs and self-statements
reprogram internal sentences and beliefs
develop positive actions steps client can carry out and practice independently
Support Group
Referral services—Legal, vocational, and/or financial services
Allow the person to grieve at their own pace.
The surviving spouse has to create a new identity as an individual rather than a couple.
Loss of social connections.
He/She has to take on responsibilities that were previously handled by the other spouse.
Allow the person to grieve at their own pace.
The surviving spouse has to create a new identity as an individual rather than a couple.
Loss of social connections.
He/She has to take on responsibilities that were previously handled by the other spouse.
Newly Divorced or Seperated
Death of a Pet
Individual counseling—
Asses for levels of grief, guilt, and
Brainstorm ways to commemorate pet’s life and how they will transform this loss into growth
With children, play therapy and ceremonial events may be employed, as well as displaying symbolic objects that remind the child of the pet, and link child to the pet
Family Therapy—
Allow the family to talk about pet’s death in an honest and factual way
Brainstorm with family on ways to commemorate pet’s life and how they will transform this loss into growth
Interventions For the Death of A Pet
Crisis Workers
Auman, M. (2007). Bereavement support for children. The Journal of School Nursing, 23(1), 34-39. doi:10.117710598405070230010601
Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: D. C. Health.
Dopp, A., & Cain, A. (2012). The role of peer relationships in parental bereavement during childhood and adolescence. Death Studies, 36(1), 41-60. doi:10.1080/07481187.2011.573175
Hoffman, M. A. (1996). Counseling clients with HIV disease: Assessment, intervention and prevention. New York: Guilford Press.
Horowitz, M. J., Siegel, B., Holen, A., Bonnanno, G., Milbrath, C., & Stinson, C. H. (1997). Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry, 154(7), 904-910.
James, R. K. (2008). Crisis intervention strategies (6th ed.). Belmont, CA: Brooks/Cole.
Middleton, W., Raphael, B., Burnett, P., & Martinek, N. (1998). A longitudinal study comparing bereavement phenomenon in recently bereaved spouses, adult children, and parents. Australian & New Zealand Journal of Psychiatry, 32, 235-241.
Nord, D. (1997). Multiple AIDS-related loss: A handbook for understanding and surviving a perpetual fall. Washington, DC: Taylor & Francis.
Raphael, B., & Minkov, C. (1999). Abnormal grief. Current Opinion in Psychiatry, 12, 99-102.
Rando, T. A. (1996). Complications in mourning traumatic death. In K. J. Doka (Ed.), Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke (pp. 139-160). Washington, DC: Hospice Foundation of America.
Schneider, J. (1984). Stress, loss, and grief: Understanding their origins and growth potential. Baltimore: University Park Press.
Williams, R. J., & Stafford, W. B. (1991). Silent casualties: Partners, families, and spouses of persons with AIDS. Journal of Counseling and Development, 69, 423-427.
Worden, J. W. (1991). Grief counseling and grief therapy: A handbook for the mental health practitioner (2nd ed.). New York: Springer.
5 Stages of Grief
When you think about death and dying, do you consider yourself to be:
Death Defying
Death Denying or
Death Accepting?

When working with clients who are grieving, therapists and crisis workers should watch for the following characteristics:
The person cannot speak of the deceased without experiencing intense and fresh grief.
Some relatively minor event triggers an intense grief reaction.
The survivor cannot remove material possessions or belongings of the deceased.
Loss themes continually come up during interviews.
The griever manifests the same physical symptoms as those the deceased had.
The individual exhibits radical changes in lifestyle following the death or excludes family, friends, activities, or visitation of places associated with the deceased.
The person experiences a long history of depression following loss, often earmarked by persistent guilt and lowered self-esteem.
A compulsion to imitate the dead person is prevalent.
Self-destructive impulses or suicidal ideation is in evidence.
Unaccountable sadness at certain times of the year is manifested.
The person has phobias about illness or death.
There is definite avoidance of death-related rituals or activities.
There is obsessive reconstruction of events surrounding the death.
The loss focuses on what was happening in the relationship at the time of death (usually negative) to the exclusion of the complete span of the relationship (more positive).
Secondary losses such as the loss of a house or savings due to a lack of planning, impetuous spending, or vulnerability to scams occur and cause financial problems.
There are compulsive and obsessive attempts to fix blame and assign responsibility if the death was caused by humans.
Clues for Identifying Complicated
Grief Reaction
Mourning is classified as complicated grief only after the symptoms have been present for a year or more.
(Horowitz et al., 1997)

Two dynamics lead to complicated grief:
“The person denies, represses, or avoids aspects of the loss, its pain, and the full realization for the mourner.”
“The individual holds onto and avoids relinquishing the loved one.”
(Rando, 1996)
Complicated Grief and Mourning Reaction:
Intervention Strategies
Applied Stages of Survivor Grief:
An Operational Concept
Stage 1 – Shock, Sadness, Anxiety, and Isolation
During this stage it is important to receive help for daily activities such as cleaning house, cooking meals, and childcare.
Stage 2 – Sadness
The loss becomes acutely felt.
Stage 3 – Loneliness
The individual may feel all alone and isolate themselves.
Stage 4 – Anger and Guilt
Stage 5 – Depression
The individual begins to understand that the deceased is not coming back, which may lead to feelings of depression.
Stage 6 – Refocus on the Future
The individual begins to feel joy again.
He/She thinks of the future in more positive terms and makes plans for the future.
Listening to Grievers: A Worker imperitive
Empathic listening is the most important skill in working with the bereaved.
A strong therapeutic alliance is also important as it makes clients feel safe in sharing their feelings of grief.
Full transcript