Sunday, March 03, 2013
Grief Therapy Techniques & Guide
Humans tend to make bonds of affection or attachment with others. When these bonds are broken, as in death or separation, a strong emotional reaction occurs, which is defined as “grief.”
In general, grief has been often associated with death and dying. However, in recent years, the association of grief is also recognized with any loss, being the deprivation of a meaningful relationship, separation from a pet, a friend, a family member or even marriage, job, health, role and identity.
Grief is a very powerful emotion. It is really painful and exhausting. It is real. It is hard. Depression shares common features with grief and this grief can completely take over the way you think and feel. Grieving is extremely tiring both physically and emotionally. When experiencing trauma which has changed our lives and circumstances and our routines, we grieve the loss of our old life. The grief changes us completely for good or bad. We are forever changed by our experience, but it does not have to be negative always. However the way each and every individual and families cope with separation (not only by death, but also by divorce, broken family, diagnosed with terminal illness both for the patient and caregiver, etc.), grief, loss, and bereavement is as unique as a fingerprint. This person's response or reaction to loss has physical, psychological, social, emotional, behavioral and spiritual components.
Anticipating the impact of loss or and during and after the events of loss or trauma, each person has unique emotional experiences and ways of coping and grieving and of reacting or not. But when it is sudden, violent or unexpected loss or trauma, then that imposes additional strains on coping. When a community is affected such as by disaster like natural calamities or epidemics, both the cost and sometimes the supports are greater.
Although we grieve many losses throughout a lifetime, such as losing a job or a home, the death of a loved one is especially difficult. In fact it is probably the most painful of all human experiences. Whether it is a parent, child, friend or a pet, a whole host of feelings is triggered by loss, and the only way to truly heal from the loss is to fully experience those feelings.
The impacts of the grief are particularly challenging times for children also, who may have had little experience managing strong effects 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.
The grief felt by an individual is not just for the person who died/separated, but also for the unfulfilled wishes and plans of/with the person. Death often reminds people of past losses or separations. The person who are grieving will try to withdraw from their friends and family and feel helpless and in some cases some might be angry and want to take action.
Given the right skills and cope up methods, we can allow this process of grief to move through us and even it can become a tool for the development of great insight. The majority of people who survive loss and trauma skillfully do not go on to develop post traumatic depression syndrome.
But, majority of us are stuck with that and are unaware of how we are meant to deal with the sadness and hence the depth of emotion will be welling up within us. This undealt grief could initiate a whole chain of chronic dysfunction, confusion, depression, avoidance behaviors and general unhappiness. The complications of the grief reaction are many.
According to Worden (1982), there can be feelings such as sadness, anger, guilt, anxiety, loneliness, shock, yearning, numbness, helplessness etc., physical sensations which include fatigue, tightness in the chest and throat, a dry mouth, a hollow feeling in the stomach and more. There might be various thoughts going in the mind of that grieving person that can lead to depression, obsessions, confusion or even hallucinations and behaviors such as disturbed sleep, social withdrawal, crying, neurotic responses to old possessions and memories, absent-mindedness, searching and calling out, restless overactivity and so on.
Mourning/grieving may be described as having the following three phases:
The urge to bring back the person who died/separated.
Disorganization and sadness.
They cannot be grieving all the day as it is certain that their bereavement will be interrupted by their practical issues of survival or have to be strong by hiding their loss for the benefit of family and friends. They have to cope up with other life events and have to adapt in this process of grieving. In such cases, their grief can remain unresolved and later resurface as an issue for counseling/therapy.
In all places and cultures, the grieving person benefits from the support of others. Time and the comfort and understanding loved ones who come to their aid will be of support to that individual in their own time and their own way. Where such support is lacking, counseling and therapy may provide an opening for healthy resolution. There are a number of different ways that the person with grief can find comfort and help during these times of sadness and here comes the grief counseling and therapy.
The bereaved person may even find himself/herself thinking that he/she is going crazy by the behavior of friends and relatives telling and sometimes dictating them how he/she should behave. Grief counseling or grief therapy is best used by those individuals who need the opportunity to talk confidentially and who want help while working through the stages of grief.
The four tasks that are necessary are:
Task 1: Accept the reality of the loss.
Task 2: Experience the pain of the grief.
Task 3: Adjust to an environment in which the deceased is missing.
Task 4: Withdraw emotional energy from the deceased and reinvest it in other social activity without uncertainty or guilt.
The goal of the counselor/therapist is to encourage the completion of these tasks. Neither the phase nor the task models should be considered as invariable patterns. They are, however, useful guidelines that may be used when appropriate.
WHEN GRIEF THERAPY IS NECESSARY?
Rituals and ceremony can help us. There is no time frame for grieving. However, if you are feeling deeply depressed for a long period of time after the separation of someone (6 months on) then there arises the need to seek help and medical advice. You may have clinical depression and need some short term intervention.
There is a difference between grieving and depression. It is normal to have bouts of deep sadness, crying, not interested in any tasks or routines, getting out of bed, and feelings of intense loneliness following the loss of a loved one. In the case of death, after the funeral when friends and family have gone back to their lives and you are left with your feelings and loneliness, is when help is most needed. This help can come from someone who has been through the experience, and truly understands the nature of grief and grieving or from a good and supportive friend, who will listen and not give advice, someone who ‘gets it’, without you having to explain.
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.
GRIEF COUNSELING AND GRIEF THERAPY:
Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones or with major life changes that trigger feelings of grief (like diagnosis of some terminal illness or divorce or breakup, etc.).
THE GOALS OF GRIEF COUNSELING:
Helping the individual to accept the loss by helping him or her to talk about the loss.
Helping the individual to identify and express feelings related to the loss (for example, anger, guilt, anxiety, helplessness, and sadness).
Helping the individual to live without the person who died and to make decisions alone.
Helping the individual to separate emotionally from the person who died and to begin new relationships.
Providing support and time to focus on grieving at important times such as birthdays and anniversaries.
Describing normal grieving and the differences in grieving among individuals.
Providing continuous support.
Helping the individual to understand his or her methods of coping.
Identifying coping problems that individual may have and making recommendations for professional grief therapy.
Grief therapy utilizes specialized techniques that help people with abnormal or complicated grief reactions and helps them to resolve the conflicts of separation.
It should be noted that grief counseling and grief therapy are not for everyone and are not the "cures" for the grieving process, but they are opportunities for those who seek support to help to move or get transformed in a most positive to find a new "normal" in their lives. They will also come to understand in a better manner to cope up with the situation by accepting the fact that after a loved one dies, one does not remove that person from his or her life, but rather learns to develop a new relationship with the person now that he or she has died. Writer Carol Crandall states in “Mediations for Healing after the Death of a Loved One” as, "You don't heal from the loss of a loved one because time passes; you heal because of what you do with the time.”
So grief therapy is defined as a kind of psychotherapy used to treat severe or complicated traumatic grief reactions, 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.
These changes during the phase of grieving may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning, conflictual problems or sudden and unexpected mourning.
Grief therapy includes dealing with blockages to the grieving process, identifying any unfinished business with the deceased/separated and identifying other losses that result from that death or separation. The grieving person must come in terms with the loss and acknowledge that the loss is final and to picture a life after that grieving period.
This grief therapy may be available as individual or group therapy like for those people who are diagnosed with any terminal illness and also for the caregivers.
Grief therapy is most appropriate in situations that fall into three categories:
The complicated grief reaction is manifested as prolonged grief.
The grief reaction manifests itself through some masked somatic or behavioral symptom.
The reaction is manifested by an exaggerated grief response.
Let us seem them in detail.
(I) Prolonged Grief:
Persons who experience this difficulty are consciously aware that they are not coming to an adequate resolution of their grief even though the loss has occurred many months or even years earlier. Often the reason behind this type of complicated grief reaction is a separation conflict leading to the incompletion of one of the tasks of grieving. In this type as the people acknowledge the intensity of the problem, normally they are self-referred. Much of the therapy involves ascertaining which of the grief tasks has yet to be completed and what the impediments to this completion are, then making a forward step by addressing that particular issue.
(II) Masked as Somatic or Behavioral Symptoms:
Here the people are usually unaware that unresolved grief is the reason behind their symptoms. However, a simple diagnosis reveals unresolved grief of a much earlier loss as the root cause of the problem. People usually experience this kind of complicated grief reaction because at the time of the loss, the grief was absent or its expression was inhibited or suppressed. Consequently, their grieving was never completed and this caused complications that will be surfaced later as somatic or behavioral symptoms.
(III) Exaggerated Grief:
Here it is very difficult to define this type of grief very precisely because of the wide variety of manifestations that normal grief can take, but persons falling into this category would be those with excessive depression, excessive anxiety, or some other exaggerated problems, so that the person becomes dysfunctional and a psychiatric disorder diagnosis come into picture.
Grief therapy emphasizes the therapeutic goal of achieving emotional wellness after the loss or separation of a significant other through the grieving process. In some cases, specific cognitive-behavioral techniques for both grief counseling and grief therapy are available.
In grief therapy six tasks can be used to help a person to work through his/ her grief:
Develop the ability to experience, express, and adjust to painful grief-related changes.
Find effective ways to cope.
Establish a continuing relationship with the person who died/separated.
Stay healthy and keep functioning.
Reestablish relationships and understand that others may have difficulty empathizing with the grief he is experiencing.
Develop a healthy image of herself/himself and the world.
The following verbs are important steps in grief counseling/therapy:
Care, learn, attend, control, listen, accept, share, reinforce, innovate and finally refer if you need to do so.
APPROACHED USED IN GRIEF THERAPY:
As everyone grieves differently, the techniques of grief therapy in each and every individual is quite varied according to their needs. One person may simply want someone to sit and listen, while another might prefer spiritual counseling to help him or her work through and accept loss, some may need group therapy. So it is a mutual understanding between the therapist and the individual about the way the issue is to be addressed.
But if the grieving person feels uncomfortable with a counselor or therapist, then it will be difficult for him or her to process the grief and work through it. Therapists should try to understand this and may provide referrals to people whom they think would tackle that particular individual in his way.
A contract is set up with the individual that establishes the time limit of the therapy, the fees, the goals, and the focus of the therapy.
Counseling and therapy techniques include art and music therapy, meditation, creation of personalized rituals, bibliotherapy, journaling, communication with the deceased/separated (through writing, conversations, etc.), Cognitive Behavior Therapy, Schema Therapy, Interpersonal Psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR); bringing in photos or possessions that belonged to the person who has died, role playing, bearing witness to the story of the loved one, confiding in intimates, and participating in support groups.
With children and young people, mostly art and creative therapy techniques may be used. A Chinese proverb proclaims that a picture is worth a thousand words. When children experience a loss, they may not have the vocabulary to articulately express their grief or to be consoled. So in this case, art therapy is used to identify, name and draw their feelings related to the death of a loved one and then those feelings are addressed.
One more technique called the "empty chair" or Gestalt therapy technique is also an approach widely used by grief counselors and grief therapists. This technique involves having an individual talk to the deceased/separated in an empty chair as if that person were actually sitting there. After sometime, the same individual is made to sit in that chair and is asked to speak from that person's perspective. The dialogue will be in first person in the presence of a counselor or therapist.
HOW EFFECTIVE IS GRIEF THERAPY?
Various factors will determine the effectiveness of grief counseling or grief therapy. Some counselors and therapists make use of some instruments to measure the effectiveness of the therapy sessions. Others rely upon subjective comments from the client, his or her family, and also through behavior observations, cognitive responses, symptom relief, and spiritual discussions. Because grief is a process and not an event, what takes place along the grief journey may alter how one continues to cope and adapt to loss. It is not necessary that the person who has experienced a loss or multiple losses will face the future hardships very easily.
Grief counseling and grief therapy are metaphorically learning to dance. Each one of us looks at the world through a different set of lenses and as a result, one's dances, steps, upbringing, hopes, dreams, and healing are dependent on many factors. Grief counseling and therapy are about sharing a person's journey before or after a death/separation. The focus here is being just a companion to them during difficult times and not rescuing or fixing them, by just listening to their stories and thoughts with an open mind and open heart. The grief counselor or therapist's role in helping others is to bring transitions and new beginnings for those individuals with whom they work.
Even though sometimes it seems easier to avoid confronting these feelings of grief, this approach is not a viable long-term solution. Buried grief can manifest itself later as physical or emotional illness and will affect those people and also their immediate family and friends. So working through your sorrow and allowing yourself to express your feelings by one way or the other will help you to heal. If grief is dealt with effectively it can initiate insight and otherwise if it is dealt with unskilfully, complications may arise.
Grief work is not easy. As it is said, “Grief is so high that you can’t get over it, so low that you can’t get under it, so wide that you can’t get around it. The only way to do it is to go through it”. Counselors and therapist and also pastors can be vital facilitators in the process of the grief. So rather than being impaired by all sorts of unhealthy responses towards grief, the bereaved can be helped to have new growth by acknowledging the loss, then to choose to live again by seeing the hope of new doors open in one’s life...
““For my thoughts are not your thoughts, neither are your ways my ways,” declares the LORD. “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts.” -Isaiah 55:8-9