SSA EDF5062 - Lecture 1 Slides
SSA EDF5062 - Lecture 1 Slides
EDF5062
Grief and Trauma Counselling
Warning
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Agenda
• Introduction to Grief Theories and Models
• Meaning Reconstruction
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2. A shift away from the idea that successful grieving requires “letting
go” of the one who has died, and toward a recognition of the
potentially healthy role of maintaining continued symbolic bonds
with the deceased
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Identity Reconstruction
Neimeyer, R. A. (2001). Reauthoring life narratives: Grief therapy as meaning
reconstruction. Israel Journal of Psychiatry & Related Sciences.
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Grief is…
…our response to loss
a multi-faceted experience:
• Feelings
• Physical
• Cognitions
• Behaviour
• Interpersonal
• Spiritual or philosophical
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Sigmund Freud
Publication of
Trauer und Melancholie
Mourning and melancholia (1917)
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Sigmund Freud
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Sigmund Freud
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Attachment Theory
• We are naturally motivated to develop and maintain attachments to others
for whom we provide and from whom we receive care.
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Attachment Theory
Attachments vary in:
• Strength
• Security
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Patterns of Attachment
Mary Ainsworth (1971) Four patterns of infant attachment. The strange situation
test. Separation/reunion with mother at 12-18 months
• Secure attachment – confident of available parent
• Anxious resistant – uncertain if parent will be helpful or responsive –
separation anxiety
• Anxious avoidant attachment – expects to be rebuffed – tries to be
emotionally self sufficient
• Disoriented/Disorganised attachment – link to physical/emotional abuse –
erratic unpredictable parenting
Early patterns of attachment as predictors of later development
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Mediators of Mourning
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Mediators of Mourning
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Mediators of Mourning
4. Historical Antecedents
What Has Gone On Before
How Was It Dealt With
5. Personality Variables
Age and Gender
Coping Style
Attachment Style
Cognitive Style
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Mediators of Mourning
6. Social Mediators
Support Satisfaction
Social Role Involvements
Religious Resources and Ethnic Expectations
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Mediators of Mourning
7. Concurrent Stresses
(Accumulative Stressors)
Financial Difficulties
Life Change Events, Job Loss etc.
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Tasks of Mourning
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Dead
Why is it such a difficult word to use?
Ashes to ashes, dust to dust Deceased In Hell (or Heaven) Shuffled off the mortal coil
Asleep Defunct In repose Six feet under
At room temperature Demised In the grave Sleeping with the fishes
Be taken Departed Inanimate Snuffed
Become living-challenged Destroyed, as in “to destroy dogs” Joined the choir invisible Snuffed out
Belly up Dirt Kicked off Sprouted wings
Bereft of life Dirt nap Kicked the bucket Stiff
Bloodless Done for Late Stone dead
Bought the farm Eat it Lifeless Succumbed
Bump off Erased Liquidated T.U./Toes up/tits up/tango uniform
Buried Ex- Lost Terminated
Buy a pine condo Executed Mortified That good night
Buy it Expired No longer with us Whacked
Cadaverous Extinct No more Wandering the Elysian Fields
Carked (it) Finished Off the twig Wasted
Cash in (or out) Fragged Offed With the ancestors
Ceased to be Gathered to his people On the wrong side of the grass Worm food
Check out Get your wings Paid Charon's fare
Checked out Give up the ghost Passed...(over, on, away, etc)
Cold “going to the big ___(whatever) in Perished
Conk the sky” Popped off
Croak Go into the fertiliser business Pushing up the daisies
Crossed over Gone Put down
Crossed the bar Gone into the west Resting in peace
Crossed the River Styx Gone to meet their maker Return to the ground
Cut off Got a one-way ticket Rubbed out
Dance the last dance In a better place Run down the curtain
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therapeutic misadventure,
diagnostic misadventure of the
highest magnitude,
substantive negative outcome
the patient failed to fulfil his
wellness potential.
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Tasks of Mourning
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Tasks of Mourning
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Tasks of Mourning
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Disenfranchised Grief
(Doka, 1989, p. 4)
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Social System
Cultural, religious & linguistic discourses that shape private
and public mourning
Family System
Myths, rules & hierarchies that
constrain and enable grief
Self System
Coping styles, resources, narratives
of bereaved individual
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Everyday life
experience
Loss- Restoration-
Oscillation:
oriented Normal grief oriented
Absent or
Chronic grief inhibited grief
Figure 1
Dual Process Model of Coping with Bereavement: Normal & Complicated Grief
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Everyday life
experience
Loss- Restoration-
oriented oriented
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Everyday life
experience
Loss- Restoration-
oriented oriented
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(Janoff-Bulman, 1992)
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(i.e., The world is basically a good place and people are generally
trustworthy)
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• Other types of losses that may not involve death can also trigger
the need to re-build and re-learn one's assumptions about the
world in a way that preserves a sense of coherence and safety.
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(Neimeyer)
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…as an explanation for an event that renders it consistent with one’s assumptions
or understanding of the nature of the social world.
That is, an event “makes sense” or “has meaning” when it does not contradict
fundamental beliefs about justice, order, and the distribution of outcomes.
One may make sense of an event by interpreting the event as consistent with
existing views of the self or of the world or by changing self or worldviews to be
consistent with the interpretation of the loss.
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“The formation of secure attachment in the first two years of life (usually involving
mutual gaze and episodes of play) triggers elevated levels of endogenous opioids and
dopamine in both mother and the child and appears to be essential to the
development of right prefrontal orbital mediated capacities for emotional self
regulation”.
Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York: Norton.
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What makes
something Brain’s priority Brain’s priority
emotionally to keep us safe for coherence
traumatic?
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“Although mourning involves grave departures from the normal attitude toward life, it
never occurs to us to regard it as a pathological condition and to refer it to a medical
treatment. We rely on its being overcome after a certain lapse of time, and we look upon
any interference with it as useless or even harmful”
— Freud, 1917
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Why Intervene?
Significant minority not fine and at risk for enduring distress and dysfunction
• Interventions improve their quality of life; potentially reduce adverse
outcomes:
• Social withdrawal, suicidality, alcohol abuse, high blood pressure,
functional disability, loss of productivity
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(Neimeyer)
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— Thomas Attig
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Creative Ideas
One of the hardest things about grief is the feeling of helplessness - doing something
often helps
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Stang, H. (2016). Compassion and loving-kindness meditation In R. A. Neimeyer (Ed.), Techniques of grief
therapy: Assessment and intervention (pp. 161-164). New York, NY: Routledge.
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Set aside a specific amount of time each day (use a timer, a collection of
music) to open the drawer, go through its contents, and enter their grief
as fully as they need to.
At the end of the allocated time things are returned to the drawer.
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Linking Objects
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Angela Dark, sister of deceased Bali victim Anthony Cachia in her brother's bedroom in Melbourne.
Angela has had her brother's portrait tattooed on her shoulder.
© The Age
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Memory Books
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Recruiting Ritual
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Ritualisation
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Ritualisation
• providing an ongoing sense of connection to the loss, allowing space to safely confront
ambivalent or confused feelings or thoughts
• generating social support, and
• offering opportunities to find meaning in the loss by applying spiritual frameworks to that
loss.
Rituals of:
• Continuity
• Transition
• Reconciliation
• Affirmation
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Emotional
Dysregulation
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Window of Tolerance
Use mindfulness, Overreactive, unclear
Use mindfulness,
breath work,
Hyper-aroused thought, emotionally
breath
physical work,
activity distressed
physical activity
Flight / Fight Response
Flight / Fight Response
Comfort Zone
Ability to self-soothe
The body is in it’s optimal state, Can access both reason and emotion, Mentally engaged
Use mindfulness,
Use mindfulness,
Depressed,
Depressed, lethargic, Hypo-aroused
numb, unmotivated
lethargic, numb, breath
breath work,
work, physical
Freeze Response activity
physical activity
unmotivated Freeze Response
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Finding Meaning
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Difficult Memories
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Memory Books
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Photo Gallery
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Reflective Reading
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Cinema-therapy
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Cinema-therapy
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• They can provide a bridge into feelings and issues that are
difficult to speak to in a more direct fashion.
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Journals
Indications
• Especially when losses are traumatic they may be
difficult to discuss or even disclose to another. Writing
can have positive impact upon a sense of well-being and
an increase in immune functioning.
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Journals
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