Sunday, January 11, 2015

Risk factors, stages and patterns of grief response

DSM Diagnosis under Other Conditions That May be Focus of Clinical Attention, V62.82, Bereavement- used for death of a loved one.
Depression in this case is considered “normal” but individual my be seeking treatment to relieve symptoms such as insomnia or anorexia.
Expression of “normal” bereavement time is relative to different cultures.
Major Depressive disorder is not diagnosed unless symptoms last longer than two months after loss.

Stages of Grief:
Denial
Anger
Bargaining
Depression
Acceptance

Reactions commonly seen in children:
o Disbelief- children may act as if it did not happen.
o Complain of headaches, stomachaches, or fear of their own death.
o Anger- concern over own needs and about being alone, or with God.
o Guilt- feelings of causing death, or not having been “better”
o Anxiety/Fear: may become clingy and need validation of love.
o Regression: revert to bed wetting or thumb sucking
o Sadness: lethargy and isolation

Short Term Treatment Goals
Express fear and anger, grieve in a healthy way.
Loss and Grief Counseling Group
Recall fond memories
Create a phone list of supportive people to call
New coping techniques
Find a “safe place” to spend limited time thinking about deceased
Exercise regiment
Relaxation techniques- progressive muscle relaxation, guided imagery

Long Term Treatment Goals
Reach a point of coping without being overcome with grief.
Regain normal activity.
Reduce feelings of guilt and anger towards self, others, and God.
Re-mature over regressed behaviors
Understanding of death and life.

Therapeutic Interventions
Writing Activities
o Letter to deceased for closure
o Journal of thoughts (may be shared in counseling, in group, or with family members)
Art therapy:
o Finger paints are useful in expressing feelings
o Draw pictures of activities enjoyed with deceased (useful with children).
o Collage on a theme
o Splatter room: area where (particularly children) are free to throw violent splotches of paint to get anger out.
Play Therapy:
o Model clay or dough to vent anger or create ritual objects
o Puppetry- to express feelings
o Sand tray to play out themes, “burry” deceased for closure, or rake sand for relaxation or meditation.
Bibliotherapy:
o Appropriate self help books
o Books related to symptoms client is displaying
Loss Graph or Timeline:
o Used to discuss types of loss
o Used to recall fond memories and celebrate life
Storytelling:
o Fantasy monologues
o Mutual storytelling
Therapeutic Metaphors
o Helpful in understanding concept of death
Empty Chair
o Gestalt technique
o Imagine deceased in chair and speak to them for closure