Term Paper: Effects on Clinicians Offering Supportive Intervention in Complex Grieving Situations

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¶ … Clinicians Offering Supportive Interventions

A caregiver is an individual who takes care of a patient. he/she may be a family member or a professional clinician. This, more often than not, leads to the onset and development of caregiver 'depressive symptoms', especially when the patient has been ill for a long period of time, and has needed constant and round the clock care for a number of years. (Mittelman; Roth; Coon; Haley, May 2004) Supportive intervention can also refer to 'crisis intervention', which means that the caregiver will use certain short-term and immediate methods to support and help those individuals who have experienced any incident or event that produces emotional, mental, physical or behavioral stress and strain and distress. The individual may, at that particular point of time, immediately after the traumatic event, find that he is not able to fully use his natural ability to cope or to solve problems. (Crisis Intervention)

The complex grieving situation may be any one of these, or a combination of one or two events: a life threatening situation, such as a criminal victimization, or a natural disaster, like an earthquake, a sexual assault or rape, the sudden onset of a medical illness, or a mental illness, thoughts of suicide, or at times, homicide, or a sudden loss of a loved one in a tragic situation. When a caregiver is faced with the individual who has just undergone and experienced this type of crisis situation, he will, at the outset, attempt to reduce, to a certain extent at least, and the intensity of his emotional, mental, and physical and behavioral reactions to the crisis. He will then help and aid the patient to return to the level of functioning that he had before the trauma. The caregiver, in this case the clinician, will be responsible for developing new and effective coping skills for the patient, and also for eliminating the generally ineffective methods of coping that the patient may be indulging in at the moment, like for example, withdrawal, substance abuse, or isolation. When the patient learns the better methods of coping that the clinician caregiver teaches him, he would be better able to cope, and also be able to reap the benefits of coping skills at a later date in his future. (Crisis Intervention)

The clinician is at times expected to face the traumatized patient, who has undergone a crisis and is at present going through a grieving process, independently, and offer to teach the patient effective methods of coping. One such method is the 'non-violent crisis intervention method', wherein the caregiver adopts a safe and a harmless and non-violent behavior management system, which would provide the best and most effective care for the patient, even when he is at his most traumatized and perhaps violent stage of reaction. For example, the caregiver is trained to notice a set of behaviors, which would lead the patient into committing violent acts: when a patient is reaching a high level of anxiety, there would be a noticeable change in his behavior, wherein he would pace to and fro or he would start to drum his fingers rapidly, or he would repeatedly wring his hands, or stare constantly at an object or a person. (Non-Violent Crisis Intervention)

When the clinician notices these symptoms of anxiety, he can immediately offer a non-judgmental support, and thereby, calm him down and bring down his anxiety levels. If for example, the patient has started to become belligerent, and starts to challenge authority, then it means that he has lost his rationality. At this time, the clinician must be trained to be supportive, and at the same time, to be able to take full control of a potentially dangerous situation, by setting limits for the traumatized and grieving patient. At times, the patient may lose complete control, and start to physically act out the traumatic episode that he has been subjected to. The clinician must be able to use restraint, with no small amount of caution; until such time that the patient may be able to regain full control of him. He must also be equipped to re-establish communication with the patient, after the patient has recovered form his irrational episode. (Non-Violent Crisis Intervention)

It must be remembered that care giving for the elderly group of population is an art in itself, and this is because of the fact that every one does have a pre-conceived notion of what it means to be old. More often than not, these opinions would have been formed when one was young and inexperienced, and based on one's own experiences with family members and friends. Caregivers of the old therefore must, at the very outset, unlearn their preconceived ideas of the elderly, and learn what it means to take care of them, and offer support when they are in a grieving situation. It has been stated time and again, that the very tapestry of old age has a functional, as well as an aesthetic and visual use for the clinician caregiver, wherein he can learn to be a better caregiver from listening and taking note of the numerous and varied stories of experiences that old age inevitably provides to the young. (McCall, 1999)

In another common complex grieving situation, a child loses his parent, to, for example, disease. The surviving parent would, therefore, have to take up, immediately, the task of taking care of the child. He would have to provide understanding, emphatic nurturance and discipline, among other things. Most importantly, however, the child would have to be given reassurance that he would be taken care of very well, and that the no harm would come to the surviving parent. (Christie, 2000) Care giving, however, must never be romanticized or at the same time, trivialized; it can be an extremely trying process, even in the best of situations. At times, the individual who cares for a bereaved or traumatized person may well be affected himself by the devastating range of emotions that he has to witness while offering intervention, day after day. (Davidson, 1999)

When, for example, the 9/11 terrorist attacks took place, hundreds and thousands of people were left suddenly deprived of children or spouses or parents, and in the immediate aftermath, many people were too numb and grief stricken to understand what exactly was happening. Many others were left feelings shock, grief, depression, intense emotionality, disbelief, anger, and also physically unwell as a result of this massive shock. An individual in such a situation may demonstrate traumatic grief, and this is characterized by a preoccupation with the deceased, a pain in the same area as the deceased suffered before his death, and a feeling that it is not worth living any more. Professional intervention offered by clinicians and other caregivers helped these people out a great deal. (Managing Grief after Disaster)

In one study by Strobe, undertaken to assess the outcomes of the counseling offered by support groups and others, a method was developed, wherein the extent to which an individual would confront or avoid their losses, and the outcomes of this confrontation were measured. It was found that lower scores for a widow did not influence the outcome, and for a widower, a lower score predicted a poorer outcome. However, this fact became very obvious: that early intervention, offered by a professional clinician, is a very good idea in the immediate aftermath of a disaster or a trauma. Although data suggest that even after a sudden, violent incident or a death, most people eventually grieve successfully, the initial grieving process does take up an inordinate amount of time, and most people prefer not to consult a professional to help them deal with the grief. At the same time, however, it must be remembered that a sudden loss of a loved one can be extremely traumatizing, and the intensity of emotions that the bereaved person may feel can well be truly frightening, and this would mean that professional outside intervention and support would be needed immediately, to help the person. (Managing Grief after Disaster)

Some of the useful components of grief intervention would include: providing the patient with relevant information about grief, and the various symptoms of grief, the course that it generally takes, and the complications that inevitably result from grief and trauma. The next step would be to evaluate accurately the exact nature of the bereaved person's distress and grief. This would help him to solve problems and complications arising from the grief, and also to provide the best and the most effective strategies that the patient can use to deal with his grief. The most important step of all, which the clinician can use to help the patient, is to help him to think of death in a way that would lead him towards emotional resolution. The clinician must be careful of using affect-evoking interventions and expert skill, and learn to use intervention methods that are balanced with containing and soothing strategies. According to Prigerson and Jacobs, 2001, there… [END OF PREVIEW]

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