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How to Use Narrative Therapy in Complicated Grief Counseling Anna Themanson, LPC, NCC

How to Use Narrative Therapy in Complicated Grief Counseling · Issues and Concerns of Complicated Grief •Severe impairment in functioning (Mayo Clinic, 2014) •Strained personal

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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• Withdrawn from friends, family, activities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