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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
• 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• Withdrawn from friends, family, activities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/con-
20032765
Reconstructing Meaning
• 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
• 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 (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
• 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/complicated-
grief/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
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