Complicated Grief Treatment From Both Sides Now

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Complicated Grief Treatment From Both Sides Now

Text of Complicated Grief Treatment From Both Sides Now

  • 1. M. Katherine Shear M.D. Professor of Psychiatry Columbia University Columbia School of Social Work Center for Complicated Grief www.complicatedgrief.org COMPLICATED GRIEF TREATMENT FROM BOTH SIDES NOW ADEC APRIL 2014
  • 2. What we feel for someone who is rewarding to be with we dont 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 Shear Center for Complicated Grief
  • 3. grief is a form of love (the form love takes when someone we love dies) M. Katherine Shear Center for Complicated Grief
  • 4. 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-limited M. Katherine Shear Center for Complicated Grief
  • 5. 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 accomplishment Ralph Waldo Emerson M. Katherine Shear Center for Complicated Grief
  • 6. MOURNING IS THE WAY ACUTE GRIEF IS TRANSFORMED AND INTEGRATED MOURNING IS A LEARNING PROCESS M. Katherine Shear Center for Complicated Grief
  • 7. 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 Shear Center for Complicated Grief
  • 8. WHAT WE NEED TO MOURN SUCCESSFULLY 1. Support from friends (we dont 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 Shear Center for Complicated Grief
  • 9. 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 Shear Center for Complicated Grief
  • 10. 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 block ACUTE GRIEF INTEGRATED GRIEF M. Katherine Shear Center for Complicated Grief
  • 11. BEREAVEMENT Acute grief symptoms Integrated grief CGT Targets Grief complications Interfere with healing Natural healing Resolving complicating problems Facilitating natural healing CONSTRUCTING COMPLICATED GRIEF TREATMENT (CGT) M. Katherine Shear Center for Complicated Grief
  • 12. 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 Shear Center for Complicated Grief
  • 13. 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 Shear Center for Complicated Grief
  • 14. END SESSION Summary and feedback Plans for the week RESTORATION FOCUS Rewards and self-care Personal aspirations/goals LOSS FOCUS Imaginal exercise Memories/pictures/situational revisiting BEGIN SESSION REVIEW diary and other plans Set agenda STRUCTURE OF A TYPICAL CGT SESSION M. Katherine Shear Center for Complicated Grief
  • 15. 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 work Revisiting 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 Shear Center for Complicated Grief
  • 16. REVISITING 1revisit transitive verb ()r-vi- zt : 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 revisiting A 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 revisiting A graded exposure-like procedure for revisiting the people, places and things that contain painful reminders of the loss M. Katherine Shear Center for Complicated Grief
  • 17. 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 activity M. Katherine Shear Center for Complicated Grief
  • 18. 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 Shear Center for Complicated Grief
  • 19. 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 Shear Center for Complicated Grief