Download How to Use Narrative Therapy in Complicated Grief Counseling

How to Use Narrative Therapy in
Complicated Grief Counseling
Anna Themanson, LPC, NCC
Illinois Counseling Association
Foundation
Definitions
• Bereavement
• “Bereavement is an objective fact” (as cited in Weaver, 2010, pg 10)
• Grief
• Reaction to the death of a loved one
• Mourning
• Cultural response to bereavement and grief, what one does to cope
Kastenbaum, R. J. (1998). Death, Society, and Human Experience (6th ed., Rev.). Needham Heights, Mass.: Viacom.
Weaver, J. (2010). Narratives from grief counseling: Client perspectives on effective interventions and strategies for recovery. Retrieved from
http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1111&context=edc_theses
Definitions
• Complicated grief
• Intensified and prolonged grief that results in severe impairment in functioning
(Weaver, 2010)
• Chronic grief, exaggerated grief
• Bereavement exclusion for major depressive disorder (APA, 2013)
• Clinicians can diagnose MDD after the loss of a loved one, previously not allowed even
though symptoms paralleled MDD
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Weaver, J. (2010). Narratives from grief counseling: Client perspectives on effective interventions and strategies for recovery. Retrieved from
http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1111&context=edc_theses
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Issues and Concerns of Complicated Grief
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Severe impairment in functioning (Mayo Clinic, 2014)
Strained personal relationships
Extreme avoidance of relics of the deceased
Withdrawn from friends, family, activities
Lost sense of purpose or meaning
Intense focus and attention on the death of the loved one
Mayo Clinic. (2014). Complicated grief. Retrieved from http://www.mayoclinic.org/diseases-conditions/complicated-grief/basics/symptoms/con20032765
Reconstructing Meaning
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Critical component to processing grief and mourning
Human beings must construct meaning in order to understand experiences (Neimeyer, 1999)
Constructivist view rejects “universality” of grief and focuses on individual implications
Conversations help remember and identify meaning of said life for continued connection
(Hedtke & Winslade, 2004)
• Caregivers help by navigating decisions with bereaved in amending their narratives
(Neimeyer, 1999)
• Negotiated in a social context, grounded in reality (Neimeyer, 200)
• Tacit and embedded meaning, permission for client to retain privacy
Hedtke, L., & Winslade, J. (2004). Re-membering lives: Conversations with the dying and the bereaved. Amityville, NY: Baywood Publishing Company.
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.
Why Narrative Therapy?
• Clients are empowered and have active role in ‘re-writing’ their story
• Journey is as important as the product (Neimeyer, 2000)
• Relies on own skills and abilities
• Allows client healthy distance from pain without complete avoidance (Good Therapy, 2016)
• Externalization of problem
• Serving vs. harming
• Dominant storylines influence decision making
• Some own authority of their stories, while others observe stories that are enforced for them
(Neimeyer, 1999).
GoodTherapy.com. (2016). Narrative therapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/types/narrative-therapy
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.
Interventions
• Life Imprint (Neimeyer, 1999)
• Acknowledge and recognize how the loved one influenced our lives
• Story Mountain (Patsy Way) (as cited in Neimeyer, 2012)
• Beginning, problem peak, resolution, ending
• Provides opportunity for multiple voices and can instill hope
• Find Your Voice (Gail Noppe-Brandon) (as cited in Neimeyer, 2012)
• Client writes play that externalized problems but is cathartic to share
• Client finds normalcy in feedback from actors
• Loss timeline (Alison J. Dunton) (as cited in Neimeyer, 2012)
• Provides opportunity for clients to recall previous similar situations to identify strengths
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
Neimeyer, R. A. (2012). Techniques of grief therapy. New York, NY: Routledge.
Interventions
• Metaphoric Images (Neimeyer, 1999)
• Describing our loss in analogies and metaphors to increase understanding of event
• Journaling (Neimeyer, 1999)
• Allows deep insight that may not be addressed during session
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Focus on traumatic loss
Write what you rarely say aloud
Flow between objective facts and subjective reaction
Write for 15 minutes/day for four or more days without care for proper grammar
Ease back into daily activity after journaling
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
The Virtual Dream
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(Neimeyer, Torres, & Smith, 2011)
A traumatic death
A crying child
An empty house
A mountain
A talking animal
A sunrise
Neimeyer, R. A., Torres, C., Smith, D. C. (2011). The virtual dream: Rewriting stories of loss and grief. Death Studies, 35:7, 646-672.
Neimeyer, R. A., Torres, C., Smith,
D. C. (2011). The virtual
dream: Rewriting stories of
loss and grief. Death Studies,
35:7, 646-672.
Neimeyer, R. A., Torres, C., Smith,
D. C. (2011). The virtual
dream: Rewriting stories of
loss and grief. Death Studies,
35:7, 646-672.
Conclusion
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Constructing meaning is essential in working through grief and mourning
Be collaborative and do not have expectations
Respect clients privacy and hesitancy (Neimeyer, 1999)
Integrate homework
Narrative therapy is empowering
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric
Publishing.
GoodTherapy.com. (2016). Narrative therapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/types/narrative-therapy
Hedtke, L., & Winslade, J. (2004). Re-membering lives: Conversations with the dying and the bereaved. Amityville, NY: Baywood Publishing Company.
Kastenbaum, R. J. (1998). Death, Society, and Human Experience (6th ed., Rev.). Needham Heights, Mass.: Viacom.
Mayo Clinic. (2014). Complicated grief. Retrieved from http://www.mayoclinic.org/diseases-conditions/complicatedgrief/basics/symptoms/con-20032765
Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65-85.
Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.
Neimeyer, R. A. (2012). Techniques of grief therapy. New York, NY: Routledge.
Neimeyer, R. A., Torres, C., Smith, D. C. (2011). The virtual dream: Rewriting stories of loss and grief. Death Studies, 35:7, 646-672.
Weaver, J. (2010). Narratives from grief counseling: Client perspectives on effective interventions and strategies for recovery. Retrieved from
http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1111&context=edc_theses