Essay: Grief Counseling Experiencing Loss

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[. . .] " The IGTS is a 9-point scale meant to measure in a similar way as the TRIG. [7: Unknown. (2006). "A Systematic Review of the Literature on Complicated Grief." Australian Government: Department of Health and Aging. Retrieved April 14, 2011, from < http://www.health.gov.au/internet/main/publishing.nsf/Content/palliativecare-pubs-rsch-grief~palliativecare-pubs-rsch-grief-3>. ]

These two measures were thus administered for the participants at four times over six years, according to the study, and at three different junctures: pretest, posttest and 11-month and 6-year follow-ups. The results of this experiment are described below, and help us understand this important process and how we can help those bereaved grieve:

"Compared with the control group, the FBP group showed a greater reduction in their level of problematic grief (IGTS) at posttest and 6-year follow-up and in the percentage at clinical levels of problematic grief at the posttest. The FBP also reduced scores on a dimension of the ITG, Social Detachment/Insecurity, at 6-year follow-up for three subgroups: those who experienced lower levels of grief at program entry, older youths, and boys. Conclusion: These are the first findings from a randomized trial with long-term follow-up of the effects of a program to reduce problematic levels of grief of parentally bereaved youths." [8: Sandler, I.N. & Ma, Y. & Tein, J.Y. & Ayers, T.S. & Wolchik, S. & Kennedy, C. & Millsap, R. (2010). "Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents." Journal of Consulting and Clinical Psychology, 78(2). ]

This study is also important because it helps us draw conclusions as to what kind of treatments is suitable, though again, grief therapy will vary for everyone.

This study, does not mention, however, whether the children were met by a psychologist individually or with family. The latter, called family intervention, is when a counselor meets with the group of survivors, sometimes individually, but also as a family unit. The focus of such meetings would be to facilitate expression of both positive and negative effects after an individual's passing and to identify how the roles of the deceased are being taken or rejected by the surviving family members. [9: Worden, J.W. (2009). Grief Counseling and Grief Therapy. New York: Springer Publishing.]

Worden, who writes a book on Grief, explains that in the case of a father's passing, his roles may be taken up by an elder son. Yet this ought to be a careful transition, for the son may suppress his feelings to meet the demands and expectations of his new role. Thus, it is important to speak about these restructures roles within the family, especially where children are involved, and often this discussion cannot be held by a family alone. This situation must be helped by a counselor so that the family does not end up in conflict or emotional withdrawal from each other. Not only must the family talk about the newly assigned roles, but it must also find a new balance in relationships that the passing of a family member may have broken. According to Worden, after a passing in the family, "there is a need to shift and re-equilibrate family triangles. Various alliances that have been formed need to be altered. However, if no substitute is found, then the deprived member may seek homeostasis through various social, physical, or emotional illnesses." [10: Worden, J.W. (2009). Grief Counseling and Grief Therapy. New York: Springer Publishing.]

The paper has so far presented an introduction to grief therapy, and various instances in dealing with a child or an adult death, form a social, but also from a scientific perspective. The remainder of the paper will thus focus on continuing the topic of means by which to deal with grief, by exposing literature on the psychology of crisis.

First, there have been innovations in the field of grief counseling, such as utilizing Christian psychology. According to an article, "Christian grief counseling includes the idea that a loved one is in Heaven and [offers] strategies for conducting life on earth without that person." This counseling method depends on a person's faith and the mode in which a loved one passed away, and is thus useful in tailoring a specific means by which to cope with grief for those affected. This concept further believes that bereavement counseling "may offer the same types of counsel even if belief in Heaven is absent" and that many Christian counselors will offer their services to non-Christians in order to "share faith with otherwise faithless people." [11: "Christian Grief Counseling." (2011). Christia.net. Retrieved April 16, 2011, . ] [12: "Christian Grief Counseling." (2011). Christia.net. Retrieved April 16, 2011, . ]

Support in this philosophy can also come from many different types of people. Counseling can be anyone who is willing to listen, but specific questions about the faith of either the deceased or the bereaved and the afterlife are better handled by a pastor who will have performed his studies up to the Master level of education and will assist the person from both a psychological or counsel point-of-view, but also help them with faith issues. The article goes on to state that even though Christian grief counseling "may not directly help with the problem of survival," it will "create confidence in the survivors through self-concept and organizing memories." [13: "Christian Grief Counseling." (2011). Christia.net. Retrieved April 16, 2011, . ]

Other innovations have been more scientific in scope and have evolved due to various studies. Two such measures of grief have been described in the study above. However, others exist as well and will be described in detail below.

For example, as part of an assessment, an examination of eight instruments of measuring grief was included. These theories were the Texas Revised Inventory of Grief (TRIG), the Hogan Grief Reaction Checklist (HGRC), the Grief Evaluation Measure (GEM), the Revised Grief Experience Inventory (REGI), the Core Bereavement Items (CBI), the Inventory of Complicated Grief (ICG), the Inventory of Complicated Grief-Revised (ICGR) and the Bereavement Risk Index (BRI). These eight "instruments," as the study calls them, for measuring grief were "examined for validity and reliability and the practical considerations of using the various tools in the clinical context." These tools are thus useful since the measurements for which they were utilized were very complex. In combination with these instruments, three grief assessment scales were also utilized, including the Grief Experience Questionnaire (GEQ), focusing on responses to suicide, the Perinatal Grief Scale, and the Perinatal Bereavement Scale (PBS). [14: Unknown. (2006). "A Systematic Review of the Literature on Complicated Grief." Australian Government: Department of Health and Aging. Retrieved April 14, 2011, from < http://www.health.gov.au/internet/main/publishing.nsf/Content/palliativecare-pubs-rsch-grief~palliativecare-pubs-rsch-grief-3>. ] [15: Unknown. (2006). "A Systematic Review of the Literature on Complicated Grief." Australian Government: Department of Health and Aging. Retrieved April 14, 2011, from < http://www.health.gov.au/internet/main/publishing.nsf/Content/palliativecare-pubs-rsch-grief~palliativecare-pubs-rsch-grief-3>. ]

As the TRIG has already been analyzed above, I would like to start this discussion with the HGRC. The HGRC is a questionnaire composed of 61 items and is structured as a five-point scale. Its development, according to the study, was based on various bereavement interview data that was obtained from adults. When the interviews were analyzed, the testers identified six categories, including despair, panic, blame, disorganization, detachment and personal growth. The interviews were administered to over 500 adults who were recruited through bereavement support groups. The HGRC was then able to identify correlations and detect changes in bereavement responses over time. Though a total score could not be calculated, the study mentions, "a range of grief theories are offered as rationale for the various types of grief responses to each subscale (i.e. Dual Theory, Attachment Theory, etc.)." Due to some persisting ambiguities, however, it has been decided that it would be difficult to recommend the method as an instrument to measure grief. [16: Unknown. (2006). "A Systematic Review of the Literature on Complicated Grief." Australian Government: Department of Health and Aging. Retrieved April 14, 2011, from < http://www.health.gov.au/internet/main/publishing.nsf/Content/palliativecare-pubs-rsch-grief~palliativecare-pubs-rsch-grief-3>. ]

The next method, the GEM, was newly designed to screen for development of "complicated mourning responses in a bereaved adult." The instrument, also comprised of several factors, uses both qualitative and quantitative examination to assess risk factors. It also includes in its questions various elements from pre and post bereavement, thus making the study a bit more complete. The GEM, despite the small sample study, was proven to validate established measure of trauma through its indexes including the Inventory of Traumatic Grief, Impacts of Events Scale and its Treatment Outcome Package. The study further describes, "the tool was also found to be predictive of mourner adjustment one year following the initial assessment […] the extent to which the tool is able to discriminate respondents according to the severity of their grief responses warrants further testing. The instrument is also very long, which may prohibit its use in this present form in clinical practice." [17: Unknown. (2006). "A Systematic Review of the Literature on Complicated Grief." Australian Government: Department of Health and Aging. Retrieved April 14, 2011,… [END OF PREVIEW]

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