How to Use Narrative Therapy in Complicated Grief Counseling Issues and Concerns of Complicated Grief

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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

    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    • Withdrawn from friends, family, activities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