Transcript Slide 1
VA
My special thanks to…
Kenneth
Adams
Rod Baker
Sandra
Harris
Mark
Hinterthuer
Terry
Keane
Kathy
McNamara
Ed
Nightingale
Judith
Patterson
Walter Penk
Family Perspectives on
Coping with Loss
Gerald P. Koocher, Ph.D., ABPP
Simmons College, Boston, MA
V A
The Animal Model for Bereavement Research
The Insect Model for Bereavement Research
Family Bereavement Project
Preventive Intervention Following a
Child’s Death
Supported by National Institute of Mental Health
Grant No. R01 MH41791
Gerald P. Koocher, Ph.D. Principal Investigator
and
Beth Kemler, Ph.D. Co-Principal Investigator
Typical loss of social support over time
following a loss event
Perceived social support
Week 1
Mean social support
Week 6
Time elapsed since death
Patterns of family interaction
following a death
External social support rises sharply after
the loss event and then declines
Intra-familial support can be variable
Congruence
Complementary
Mutual Escape
Distancer and Pursuer
Understanding Basic Tasks of Mourning
Accepting the reality of the loss
Grieving: experiencing the pain and
emotion associated with the loss
Adjusting to the new reality
Commemoration: relocating
representation of the deceased in
one’s own life
Fundamental Intervention Strategies
Avoid parallel
service delivery;
partner with
medical team.
Focus on family
intervention
whenever
possible.
Normalize the
family’s distress.
Suggest active
coping strategies;
providing sense of
control.
Engage around
common fears
and attributions
Pay attention to
symptom relief.
Strategies for Helping Children Cope
Find
out what the child already
knows.
Anticipate the child’s fears.
Correct misconceptions.
Give clear information.
Invite questions and participation.
Children’s Unasked Questions
Did I make that happen?
Is it my fault?
Is that going to happen to me?
Is it going to happen to someone else I
care about?
Who will take care of me?
Unique Phenomena in
Pre-Operational Thinking
Imminent Justice
Bad things happen as the result of bad
behavior or bad thoughts
Limited perspective-taking skills
Inability benefit from another’s
viewpoint or experiences
Adolescents’
Issues--
Hey, Grandpa, is deathbed
one word or two?
What factors mediate the
mourning process?
The nature of the loss
event
Pre-existing relationships
Rituals
Functioning of survivors
Family and community
influences (social support
systems)
Individual characteristics
Therapeutic Family Activities
Exploring the loss
event (sharing
perspectives)
Discussing loss
histories (families
of origin)
Circular
questioning about
coping
Bibliotherapy
Discussing objects
of remembrance
Letter writing
Understanding
attributions
Commemoration
Family coping
planning
Model Intervention Session I:
Understanding each other’s loss
experience
Part I – 90 minutes
Family members tell their stories
Assure
that all speak for themselves
Exploration of coping
Circular
questioning about perceptions of
self and others
Education about grief
Child
versus Adult patterns
Session I:
Understanding each other’s loss
experience
Part I – 90 minutes (continued)
Acknowledge pain and discomfort of
discussing the loss again
Give parents reading material
The
Bereft Parent (Schiff)
Assign Homework for Session II
Each
family member to choose memory
object for next session, but avoid
discussing the choice at home.
Session I:
Understanding each other’s loss experience
Part II: parents only- additional 30
minutes
Explore dyadic issues
Sources of tension in the relationship (e.g.,
sexual disruption, replacement child, etc.)
Discuss losses in family of origin context
How were you taught to deal with loss?
Review personal loss histories
What important losses have you suffered
previously?
Session II:
Making contact with the emotional loss
Part I: parents only - first 30 minutes
Explore interval since first session
Address any recent concerns
Normalize the distress of reawakening
grief
Provide encouragement for coping
efforts made to date
Session II:
Making contact with the emotional loss
Part II: family meeting- 90
minutes
Two Exercises:
Remembering
Family
the deceased child
letter writing
Session II:
Making contact with the emotional loss
Remembering the deceased child
What reminder has each person brought?
How is the child remembered.
Where are the reminders at home?
Assess idealization.
Discuss the meaning of the item.
Are negative memories tolerated?
What has been done with the child’s room and
belongings?
Explore cemetery visits.
Discuss how the family has changed.
Session II:
Making contact with the emotional loss
Family letter writing
May be literal or figurative, written or taped.
Young siblings can draw pictures.
Goal: create emotional object to take home.
Content:
Things left unsaid
Memories shared
Unanswered questions
Session III:
Moving on with our lives
Anticipating anniversary phenomena.
Which will be most difficult for whom?
Review normal grief and “warning signs.”
Discuss re-involvement in the world for each
person.
Explore meaning-making for each person.
Philosophy of life
Hope for the future
Plan family activity outside the home.
Warning Signs:
When is professional help needed?
Staying withdrawn from
family and friends
Persistent blame or guilt
Feelings of wanting to die
Persistent anxiety;
especially when
separating from parents
or surviving children
Unusual and persistent
performance problems at
work or school
New patterns of
aggressive behavior
Accident proneness
Acting as though nothing
happened, or happier
than normal
Persistent physical
complaints
Extended use of Rx or
non-Rx drugs and alcohol
That which does not kill me postpones the inevitable.