Complicated Grief Treatment From Both Sides Now
-
Upload
cgt-research-and-training-program -
Category
Education
-
view
1.135 -
download
0
description
Transcript of Complicated Grief Treatment From Both Sides Now
M. Katherine Shear M.D.Professor of Psychiatry
Columbia UniversityColumbia School of Social Work
Center for Complicated Griefwww.complicatedgrief.org
COMPLICATED GRIEF TREATMENT FROM BOTH
SIDES NOW
ADECAPRIL 2014
What we feel for someone who…
…is rewarding to be with
…we don’t want to be separated from
…provides comfort and solace when we are feeling bad
…is our cheerleader and coach when we are out there on our own doing new things
M. Katherine ShearCenter for Complicated Grief
grief is a form of love(the form love takes
when someone we love dies)
M. Katherine ShearCenter for Complicated Grief
ACUTE GRIEF
The initial response to bereavement• Frequent strong feelings of
yearning and sorrow• A mixture of other feelings
(positive and negative)• Thinking focused frequently on the
deceased• A sense of disbelief• Feelings of insecurity• Loss of interest in ongoing life
Acute grief is usually time-limitedM. Katherine ShearCenter for Complicated Grief
INTEGRATED GRIEF
A lasting form of grief • Feelings of yearning and sorrow,
mostly muted, in the background• A mixture of other feelings (positive
and negative)• Thoughts of the deceased accessible
and bittersweet• Renewed sense of the potential
for joy and satisfaction in life
Integrated grief is permanent
To be yourself in a world that is
constantly trying to make you
something else is the greatest
accomplishmentRalph Waldo Emerson
M. Katherine ShearCenter for Complicated Grief
MOURNING IS THE WAY ACUTE GRIEF IS TRANSFORMED AND
INTEGRATED
MOURNING IS A LEARNING PROCESSM. Katherine ShearCenter for Complicated Grief
WHAT WE NEED TO LEARN
WHAT IT MEANS THAT OUR LOVED
ONE IS REALLY GONE
WHAT OUR RELATIONSHIP
WITH OUR LOVED ONE WILL BE LIKE WHO WE ARE
WITHOUT OUR LOVED ONE
M. Katherine ShearCenter for Complicated Grief
WHAT WE NEED TO MOURN SUCCESSFULLY
1. Support from friends (we don’t grieve well all alone)
2. Self-compassion
3. To honor and attend to basic human needs
• A sense of belonging• Connection to our authentic selves• Competence to meet meaningful challenges
M. Katherine ShearCenter for Complicated Grief
COMPLICATED GRIEF
Acute grief persists without a feeling of meaningful progression• Frequent strong feelings of yearning and
sorrow• A mixture of other feelings (positive and
negative)• Thinking focused frequently on the
deceased• A sense of disbelief• Feelings of insecurity and loss of interest in
ongoing life
Grief complications (thoughts, feelings and behaviors) interfere with successful mourning
M. Katherine ShearCenter for Complicated Grief
COMPLICATED GRIEF
COMPLICATED GRIEF
1. Persistence of acute grief symptoms
2. Complicating cognitive, emotional and behavioral symptoms
COMPLICATIONS Second guessing, “if only” Trying to protect oneself from
the painful reality by avoidance Managing intense emotions
ineffectively
THE TERM “COMPLICATED” used in the medical sense of a superimposed problem that interferes with healing
BEREAVEMENT
MOURNING
blockACUTE GRIEF
INTEGRATED GRIEF
M. Katherine ShearCenter for Complicated Grief
BEREAVEMENT
Acute grief symptoms
Integrated grief
CGT Targets
Grief complicationsInterfere with
healingNatural healing
Resolving complicating problems
Facilitating natural healing
CONSTRUCTING COMPLICATED GRIEF TREATMENT (CGT)
M. Katherine ShearCenter for Complicated Grief
CORE PRINCIPLES
1. People have a natural inborn capacity to adjust to loss that utilizes the adaptive unconscious
Successful mourning is facilitated by
2. Receiving meaningful support
3. Self-compassion
4. Addressing self-determination needs 1. A sense of belonging and mattering to others
2. Authenticity
3. Meeting meaningful challenges
M. Katherine ShearCenter for Complicated Grief
COMPONENTS OF CGT
Grief monitoring
Imaginal revisiting
Situational revisiting
Memories and pictures
Imaginal conversation
Grief monitoring
Building support
Personal aspirations and plans
Self care and positive emotions
Situational revisiting
Loss focus: reshaping grief
Restoration focus: remaking life
• 16-session treatment with elements from CBT, IPT, MI
• Manualized and tested in 2 NIMH-funded studies
M. Katherine ShearCenter for Complicated Grief
END SESSION
Summary and feedback Plans for the week
RESTORATION FOCUSRewards and self-care Personal
aspirations/goals
LOSS FOCUSImaginal exercise Memories/pictures/
situational revisiting
BEGIN SESSIONREVIEW diary and other
plans Set agenda
STRUCTURE OF A TYPICAL CGT SESSION
M. Katherine ShearCenter for Complicated Grief
OVERVIEW OF THE 16-SESSION FORMAT
Getting started (Sessions 1-3)• Creating companionship• Getting to know grief (e.g.
introduce GMD)• Orientation to treatment• Introducing aspirational
goals workRevisiting Sequence (Sessions 4-9)• Imaginal revisiting exercise• Situational revisiting• Memories and pictures
work• Aspirational goals work
Midcourse review (Session 10) Closing Sequence (Sessions 11-16) • Imaginal conversation• Finishing revisiting and
memories• Continuing goals work• Possible work on second
loss• Work on termination
M. Katherine ShearCenter for Complicated Grief
REVISITING
1re·vis·ittransitive verb \(ˌ)rē-ˈvi-zət\ : to go to (a place) again especially after a long period of time: to think about or look at (something) again
Full Definition of REVISIT: to visit again : return to; also : to consider or take up again
http://www.merriam-webster.com/dictionary/revisit
Revisiting in CGT• Imaginal revisitingA procedure in which we ask the person to close her eyes and visualize herself back at the time when she first learned of the death • Situational revisitingA graded exposure-like procedure for revisiting the people, places and things that contain painful reminders of the loss
M. Katherine ShearCenter for Complicated Grief
IMAGINAL REVISITING: DESCRIPTION
Revisiting is a repetitive imaginal exercise focused on returning to the time of learning of the death to visualize, verbalize and reflect on the reality of the loss
Conducted in 4 steps
STEP ONE: Visualize the time of learning of the death and describe the experience out loud
STEP TWO: Reflect on the death and the experience of visualizing and telling the story, with the help of a trusted companion
STEP THREE: Put away or set aside the revisiting image, thoughts and feelings
STEP FOUR: Shift focus to planning a rewarding activityM. Katherine ShearCenter for Complicated Grief
IMAGINAL REVISITING (CONT.)
• Revisiting is usually done weekly over a 4-6 week period and possibly a little longer.
• The exercise is recorded so the person can listen to the recording during the week at home.
• We make a new recording each session.
• The process goes faster and is more powerful if the person listens every day.
M. Katherine ShearCenter for Complicated Grief
SITUATIONAL REVISITING
• Bereaved people cannot avoid reminders of the deceased
• For people with CG these reminders are often very painful
• CGT encourages confrontation with reminders as a natural part of the healing process; facing these situations
• Provides an opportunity for reflecting on the loss
• Releases a bereaved person to resume full engagement in ongoing life
• Work with daily life reminders includes
• Difficult times
• Planned revisiting of avoided activities, places and people
• In-office work with pictures and other momentos
M. Katherine ShearCenter for Complicated Grief