Understanding Grief: Assessment and Treatment Planning

1. Understanding Grief: Assessment and Treatment Planning Karen Horinek, L.C.P.C. Bereavement Coordinator/Counselor And Terra Solove, M.S.W. Bereavement Counselor

2. What is Grief? • Grief is the physical, emotional, somatic, cognitive and spiritual response to actual or threatened loss of a person, thing or place to which we are emotionally attached. We grieve because we are biologically willed to attach. (John Bowlby, Father of Attachment Theory)

3. Common Grief ResponsesFeelings • Numbness • Shock • Anger • Anxiety • Loneliness • Fatigue • Yearning • Relief

4. Common Grief ResponsesPhysical Sensations • Tightness in the chest • Shortness of Breath • Lack of Energy • Panic Attack-like symptoms

5. Common Grief ResponsesCognitions • Disbelief • Confusion • Sense of Presence • Lack of Concentration

6. Common Grief ResponsesBehaviors • Sleep disturbances • Appetite disturbances • Social withdrawal • Dreams of the deceased • Absent-minded behavior

7. Common Grief Responses • Cultural Differences • Gender Differences

8. Differences between Grief and Depression Depression shares common features with grief. Misdiagnosis can result in overlooking depression when it is present and inappropriately treating grief. American Family Physician Article (www.aafp.org/afp/20020301/883.html)

9. Grief Experienced in waves Diminishes in intensity over time Healthy self-image * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Moods and feelings are static Consistent sense of depletion Sense of worthlessness and disturbed self-image Assessing between Grief and Depression

10. Grief Anhedonia Hopelessness Response to support Overt expression of anger * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Anhedonia Pervasive hopelessness Unresponsive to support Anger not as pronounced Assessing between Grief and Depression

11. Grief Guilt is focused on aspect of loss Not demoralizing or humiliating Preoccupation with deceased Suicidal gestures rare in uncomplicated grief Elicits sympathy, concern and desire to embrace * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Guilt is preoccupied with a negative self-image Demoralizing and humiliating Preoccupation with self Suicidal gestures not unusual in depression Elicits irritation, frustration and a desire to avoid Assessing between Grief and Depression

12. Grief Assessment • What was the relationship • Nature of the Attachment • Mode of Death • Historical Antecedents • Personality Variables • Social Variables * Adapted from William Worden. (1982). Grief Counseling and Grief Therapy. New York: Springer Publishing Company.

13. Theories on Bereavement • Elizabeth Kubler-Ross: Stages • William Worden: Four tasks of grieving • Robert Neimeyer: Rebuilding life and search for meaning

14. Treatment Planning • Establish a relationship with the bereaved • Be comfortable with their expression of grief • Listen • Normalize grief reactions • Companion them in rebuilding their life

15. Taking Care of Myself • Know your own limits • Set boundaries • Nurture yourself