Transcript
Page 1: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss, and Suicide 2.0: Finding New Life Again

P.O. Box 739 • Forest, VA 24551 • 1-800-526-8673 • www.AACC.net

Page 2: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 2

Welcome to Light University and the “Complicated Grief, Loss, and Suicide 2.0: Finding New Life Again” program of study. Our prayer is that you will be blessed by your studies and increase your effectiveness in reaching out to others. We believe you will find this program to be academically sound, clinically excellent, and biblically-based. Our faculty represents some of the best in their field—including professors, counselors, and ministers who provide students with current, practical instruction relevant to the needs of today’s generations. We have also worked hard to provide you with a program that is convenient and flexible, giving you the advantage of “classroom instruction” online and allowing you to complete your training on your own time and schedule in the comfort of your home or office. The test material can be found at www.lightuniversity.com and may be taken open book. Once you have successfully completed the test, which covers the units within this course, you will be awarded a certificate of completion signifying you have completed this program of study. Thank you for your interest in this program of study. Our prayer is that you will grow in knowledge, discernment, and people-skills throughout this course of study. Sincerely,

Ron Hawkins Dean, Light University

Page 3: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 3

The American Association of Christian Counselors

Represents the largest organized membership of Christian counselors and caregivers in the world, having just celebrated its 30th anniversary in 2016.

Known for its top-tier publications (Christian Counseling Today and Christian Counseling Connection), professional credentialing opportunities offered through the International Board of Christian Care (IBCC), excellence in Christian counseling education, an array of broad-based conferences and live training events, radio programs, regulatory and advocacy efforts on behalf of Christian professionals, a peer-reviewed Ethics Code, and collaborative partnerships such as Compassion International, the AACC has become the face of Christian counseling today.

The AACC also helped launch the International Christian Coaching Association (ICCA) in 2011, and has developed a number of effective tools and training resources for Life Coaches.

Our Mission

The AACC is committed to assisting Christian counselors, the entire “community of care,” licensed professionals, pastors, and lay church members with little or no formal training. It is our intention to equip clinical, pastoral, and lay caregivers with biblical truth and psychosocial insights that minister to hurting persons and help them move to personal wholeness, interpersonal competence, mental stability, and spiritual maturity.

Page 4: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 4

Our Vision

The AACC’s vision has two critical dimensions: First, we desire to serve the worldwide Christian Church by helping foster maturity in Christ. Second, we aim to serve, educate, and equip 1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the next decade. We are committed to helping the Church equip God’s people to love and care for one another. We recognize Christian counseling as a unique form of Christian discipleship, assisting the Church in its call to bring believers to maturity in the lifelong process of sanctification—of growing to maturity in Christ and experiencing abundant life. We recognize some are gifted to do so in the context of a clinical, professional and/or pastoral manner. We also believe selected lay people are called to care for others and that they need the appropriate training and mentoring to do so. We believe the role of the helping ministry in the Church must be supported by three strong cords: the pastor, the lay helper, and the clinical professional. It is to these three roles that the AACC is dedicated to serve (Ephesians 4: 11-13).

Our Core Values

In the name of Christ, the American Association of Christian Counselors abides by the following values:

VALUE 1: OUR SOURCE We are committed to honor Jesus Christ and glorify God, remaining flexible and responsive to the Holy Spirit in all that He has called us to be and do. VALUE 2: OUR STRENGTH We are committed to biblical truths, and to clinical excellence and unity in the delivery of all our resources, services, training, and benefits. VALUE 3: OUR SERVICE We are committed to effectively and competently serve the community of care worldwide—both our membership and the Church at large—with excellence and timeliness, and by over-delivery on our promises. VALUE 4: OUR STAFF We are committed to value and invest in our people as partners in our mission to help others effectively provide Christ-centered counseling and soul care for hurting people. VALUE 5: OUR STEWARDSHIP We are committed to profitably steward the resources God gives to us in order to continue serving the needs of hurting people.

Page 5: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 5

Light University

Established in 1999 under the leadership of Dr. Tim Clinton—has now seen nearly 300,000 students from around the world (including lay caregivers, pastors and chaplains, crisis responders, life coaches, and licensed mental health practitioners) enroll in courses that are delivered via multiple formats (live conference and Webinar presentations, video-based certification training, and a state-of-the-art, online distance teaching platform).

These presentations, courses, and certificate and diploma programs offer one of the most comprehensive orientations to Christian counseling anywhere. The strength of Light University is partially determined by its world-class faculty—more than 150 of the leading Christian educators, authors, mental health clinicians and life coaching experts in the United States. This core group of faculty members represents a literal “Who’s Who” in Christian counseling. No other university in the world has pulled together such a diverse and comprehensive group of professionals.

Educational and training materials cover more than 40 relevant core areas in Christian counseling, life coaching, mediation, and crisis response—equipping competent caregivers and ministry leaders who are making a difference in their churches, communities, and organizations.

Our Mission Statement

To train one million Biblical Counselors, Christian Life Coaches, and Christian Crisis Responders by educating, equipping, and serving today’s Christian leaders.

Academically Sound • Clinically Excellent • Distinctively Christian

Page 6: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 6

Video-based Curriculum

Utilizes DVD presentations that incorporate more than 150 of the leading Christian educators, authors, mental health clinicians, and life coaching experts in the United States.

Each presentation is approximately 50-60 minutes in length and most are accompanied by a corresponding text (in outline format) and a 10-question examination to measure learning outcomes. There are nearly 1,000 unique presentations that are available and organized in various course offerings.

Learning is self-directed and pacing is determined according to the individual time parameters/schedule of each participant.

With the successful completion of each program course, participants receive an official Certificate of Completion. In addition to the normal Certificate of Completion that each participant receives, Regular and Advanced Diplomas in Biblical Counseling are also available.

The Regular Diploma is awarded by taking Caring for People God’s Way, Breaking Free, and one additional Elective among the available Core Courses.

The Advanced Diploma is awarded by taking Caring for People God’s Way, Breaking Free, and any three Electives among the available Core Courses.

Credentialing

Light University courses, programs, certificates, and diplomas are recognized and endorsed by the International Board of Christian Care (IBCC) and its three affiliate Boards: the Board of Christian Professional & Pastoral Counselors (BCPPC); the Board of Christian Life Coaching (BCLC); and the Board of Christian Crisis & Trauma Response (BCCTR).

Credentialing is a separate process from certificate or diploma completion. However, the IBCC accepts Light University and Light University Online programs as meeting the academic requirements for credentialing purposes. Graduates are eligible to apply for credentialing in most cases.

Credentialing involves an application, attestation, and personal references.

Credential renewals include Continuing Education requirements, re-attestation, and occur either annually or biennially depending on the specific Board.

Page 7: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 7

Online Testing

The URL for taking all quizzes for this course is: http://www.lightuniversity.com/my-account/.

TO LOG IN TO YOUR ACCOUNT

You should have received an e-mail upon checkout that included your username, password, and a link to log in to your account online.

MY DASHBOARD PAGE

Once registered, you will see the My DVD Course Dashboard link by placing your mouse pointer over the My Account menu in the top bar of the Web site. This page will include student PROFILE information and the COURSES for which you are registered. The LOG-OUT and MY DASHBOARD tabs will be at the top right of each screen. Clicking on the > next to the course will take you to the course page containing the quizzes.

QUIZZES

Simply click on the first quiz to begin.

PRINT CERTIFICATE

After all quizzes are successfully completed, a “Print Your Certificate” button will appear near the top of the course page. You will now be able to print a Certificate of Completion. Your name and the course information are pre-populated.

Continuing Education The AACC is approved by the American Psychological Association (APA) to offer continuing education for psychologists. The AACC is a co-sponsor of this training curriculum and a National Board for Certified Counselors (NBCC) Approved Continuing Education Provider (ACEPTM). The AACC may award NBCC approved clock hours for events or programs that meet NBCC requirements. The AACC maintains responsibility for the content of this training curriculum. The AACC also offers continuing education credit for play therapists through the Association for Play Therapy (APT Approved Provider #14-373), so long as the training element is specifically applicable to the practice of play therapy. It remains the responsibility of each individual to be aware of his/her state licensure and Continuing Education requirements. A letter certifying participation will be mailed to those individuals who submit a Continuing Education request and have successfully completed all course requirements.

Page 8: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 8

Presenters for

Complicated Grief, Loss, and Suicide 2.0: Finding New Life Again

Page 9: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 9

Presenter Biographies Jennifer Cisney Ellers, M.A., is a Professional Counselor, life coach, crisis response trainer, author and speaker. She conducts training, counseling and coaching in the field of grief, crisis and trauma through the Institute for Compassionate Care. Jennifer is an approved instructor for the International Critical Incident Stress Foundation, teaching several CISM courses. Also, Jennifer provides divorce coaching, training and speaking through Emerge Victorious, a ministry for women rebuilding their lives after divorce. She is the co-author of The First 48 Hours: Spiritual Caregivers as First Responders, with her husband, Dr. Kevin Ellers. In addition, Jennifer co-authored, Emerge Victorious: A Woman’s Transformational Guide after Her Divorce, with Sandra Dopf Lee. Eric Scalise, Ph.D., LPC, LMFT, is the President of LIV Enterprises & Consulting, LLC. He currently serves as Senior Vice President and Chief Strategy Officer (CSO) with Hope For The Heart, an international Christian counseling ministry offering biblical hope and practical help. He is also the former Senior Vice President for the American Association of Christian Counselors (AACC) and former Department Chair for Counseling Programs at Regent University. Dr. Scalise is a Licensed Professional Counselor and a Licensed Marriage & Family Therapist with nearly 40 years of clinical and professional experience in the mental health field, and he served six years on the Virginia Board of Counseling. Specialty areas include professional/pastoral stress and burnout, combat trauma and PTSD, marriage and family issues, addictions and recovery, leadership development, and lay counselor training. As the son of a diplomat, Dr. Scalise was born in Nicosia, Cyprus, and has also lived and traveled extensively around the world. He is a published author, conference speaker, and frequently works with organizations, clinicians, ministry leaders, and churches on a variety of issues. Dr. Scalise and his wife, Donna, have been married for 38 years, have twin sons who are combat veterans serving in the U.S. Marine Corps, and three grandchildren.

Page 10: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 10

Complicated Grief, Loss and Suicide 2.0: Finding New Life Again

Table of Contents:

CGL 101: No Goodbyes: Grieving a Suicide ............................................................................. 11

Jennifer Cisney Ellers, M.A.

CGL 102: Beyond the Tears: Treating Complicated Grief ......................................................... 23

Eric Scalise, Ph.D. and Jennifer Cisney Ellers, M.A.

CGL 103: A Picture of Healing: Examples of Recovery from Loss.............................................. 30

Jennifer Cisney Ellers, M.A.

Page 11: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 11

CGL 101:

No Goodbyes: Grieving a Suicide

Jennifer Cisney Ellers, M.A.

Page 12: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 12

Summary

When a person takes their own life, their loved ones are left with feelings of grief, guilt, and

pain. Suicide is a growing problem in today’s culture, and the grief that comes when a loved one

dies by suicide needs to be understood and dealt with in a different way than other types of

grief. Suicide survivors face stigma, guilt, shame, and a myriad of unanswered questions. In this

lecture, Jennifer Cisney Ellers discusses ways that counselors can sensitively and effectively help

those who are grieving the loss of a loved one to suicide.

Learning Objectives

1. Participants will discover the prevalence of suicide in today’s culture.

2. Participants will examine the unique challenges and emotions faced by those who have

lost loved ones to suicide.

3. Participants will analyze practical techniques and tools to help suicide survivors.

Page 13: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 13

I. Suicide and Survivors

A. Statistics

1. The suicide rate has steadily climbed since 2007.

2. A growing number of people are grieving a death by suicide.

3. Nearly one million people in the world die by suicide each year.

4. Suicide is one of the top 10 leading causes of death across all age groups.

5. Worldwide, suicide ranks as one of the top three causes of death for adolescents and

young adults.

6. 2008-2009 – 8.3 million adults in the US reported having suicidal thoughts – 3.7% of

U.S. population.

7. It is estimated that 85% of people in the U.S. will personally know someone who has

completed suicide.

8. For each complete suicide, it is estimated that at least six loved ones are directly

impacted by the death.

B. Grieving a Suicide

1. Suicide survivors have a higher risk of developing Complicated Grief, which is

associated with poor psychological, physical and functional outcomes.

2. Suicide survivors share higher rates of psychiatric co-morbidity, including rates of

major depression and PTSD (Jordan, 2008).

Page 14: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 14

3. Suicide survivors are at higher risk for suicidal ideation and behaviors themselves.

4. Not all studies find higher suicide risk and higher co-morbid disorders.

5. Suicide survivors may experience:

Guilt and a sense of responsibility

Shame and stigma

C. Shame and Stigma

1. Comparing suicide bereaved individuals with other bereaved individuals across 41

studies, researchers did find higher incidences of rejection, blaming, shame, stigma,

and the need to conceal the cause of death.

2. Research shows that respondents view parents of a child who committed suicide to be:

Less likable

More to blame

More ashamed

More able to prevent death (Calhoun, Selby, & Faulstich, 1980)

D. Working with Suicide Survivors

1. Don’t state the death was suicide unless the survivor tells you this.

2. Be careful with your language – use “completed” or “died by” rather than

“committed.”

3. Death notification or finding the body can cause high levels of trauma or secondary

wounds.

Page 15: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 15

E. A Theology of Suicide

II. Issues That Need to Be Addressed with those Grieving a Suicide

A. The Need to Understand Why

1. Retracing the loved one’s final days/moments

2. Understanding means/methods/cause of death/experience

3. Suicide notes or final messages/conversations

4. Talking with those close to the individual including romantic partners, parents,

friends, co-workers or mental health or medical practitioners

B. Guilt and Personal Responsibility

1. Why couldn’t they prevent it/stop it

2. Overestimate their sense of responsibility

3. Looking for clues or warning signs they missed

4. What if/if only

5. Blaming others

Page 16: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 16

C. Anger

1. At the person who died

Feelings of rejection

Feelings of abandonment

2. At other friends/family members

3. At mental health professional

4. At God

D. Stigma/Social Support

1. Suicide stigma is unique

2. Basis in religious faith but bad theology

Past restrictions by some faith communities

Number of people told their loved one is in hell

3. Suicide survivors report finding it difficult to talk about the loss because of others

discomfort with suicide

4. Insurance

5. Military

E. Trauma

1. Sudden

Page 17: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 17

2. Majority of methods are traumatic

Firearms

Hanging

Jumping

Trains

3. Finding the body

F. Suicide Risk in Survivors

1. Studies indicate that nearly 90% of those who die by suicide are thought to have a

diagnosable mental illness at the time of their death. Some mental illnesses –

particularly those with high suicide risk (depression, bipolar disorder and

schizophrenia) have strong heredity components.

2. Suicide risk is also show to run in families – likely due to both hereditary and

environmental factors.

3. In a 1994 study by Crosby and Sacks, it was shown that people who had known

someone who died by suicide in the last year were 1.6 times more likely to have

suicidal thoughts, 2.9 times more likely to have a plan for suicide, and 3.7 times more

likely to have made a suicide attempt themselves.

G. Complicated Grief

1. Research results vary on whether grief differs based on mode of death. There are

many factors but some studies clearly indicate that survivors of suicide loss are at

higher risk for Complicated Grief.

2. Some studies show rates double that of the general population.

Page 18: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 18

H. Longer Period of Acute Grief

1. One study suggests a period of three to five years before grief begins to integrate.

Others suggest four to seven years may be a reasonable time frame for suicide

survivors.

2. Know that normal grief from suicide may differ from other grief processes.

III. Additional Resources

A. Recommendations for Counselors

1. If there are any pre-existing mental health concerns (depression, anxiety, addiction,

etc.), survivors should seek treatment right away.

2. If the death involved witness of trauma or traumatic circumstances, the individual

should be screened for PTSD after 30 days.

3. Suicide Survivor Support Groups are available in most communities across the

country and offer a valuable type of support from other survivors.

B. Recommendations for Non-clinicians Offering Support

1. Be a safe person and do not probe or judge.

2. Talk very little but listen intently and use good active listening techniques.

3. As you listen well, survivors will talk about what they need to say.

4. Listening to their story honors them and their loved one.

Page 19: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 19

5. Listening helps survivors make their situation real and paint a picture that gives them

perspective.

6. Survivors tell us that a good listener will:

Let them talk when they need to talk and respect when they are not ready

Go with it and accept whatever emotions come out

Will keep checking in

Will engage in conversations about things other than the suicide and their grief

Just hang out with them and act normal!

7. Listen for themes (Jordan, 2001)

Why did they do it?

Why didn’t I prevent it?

Why did they do this to me?

8. Specific to children:

Children are egocentric – the world evolves around them

Why didn’t they love me enough to stay?

What did I do that was so bad?

Always tell the truth

Remember: Who do you want them to hear the truth from?

Age appropriate levels of information

C. What Not to Say

1. Discounting statements: These undermine a survivor’s intelligence and emotions.

2. Examples:

At least…

Page 20: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 20

However…

But…

Your loved one is in hell

D. What to Say

1. You don’t always have to ask, “How are you doing?” Empathic statements can often

elicit more response than a question.

2. You can say things like:

What has been the most difficult thing about losing ____?

What has changed for you over the past month?

I imagine life has really changed for you the past two weeks!

Hey, I just want you to know that I have been thinking about (or “praying for”

with a person of faith) you a lot.

E. 10 Things Survivors Want Other Survivors to Know

1. Your grief journey is unique to you

2. You are going to have a lot of ups and down in your journey

3. Let people in your life

4. Choose safe people

5. Set good boundaries

6. Extend grace to yourself and others

Page 21: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 21

7. Sleep, eat healthy, and exercise

8. Be a part of something meaningful

9. Develop your spiritual health

10. Take an active role in your grief

F. Helping Survivors: Recommendations for Parents

1. Don’t make any major changes for a few months

2. Don’t take on new responsibilities that you are not able to emotionally or physically

handle

3. Talk with other bereaved parents

4. Talk with significant other but don’t make him or her your full support system

5. Accept that people grieve differently and have different needs

6. Attend to your other children, they are grieving too

G. Encourage Survivors to

1. Talk about positive memories of their loved one

2. Identify what is important to them that gives hope

Page 22: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 22

3. Just take one day at a time

4. Learn more about grief, loss, suicide

5. Stay connected: invite them for a visit, do something

6. Have time alone when needed

7. Talk with others who have walked a similar journey and explore support groups

8. Be intentional with grief rituals and ceremonies

References

Calhoun, L.G., Selby, J.W., & Faulstich, M.E. (1980). Reactions to the parents of the child suicide: A study of social

impressions. J. Consult. Clin. Psychol., 48, 535-536.

Crosby, A.E., & Sacks, J.J. (2003). Exposure to suicide: Incidence and association with suicidal ideation and behavior:

United States 1994. Suicide Life Threat Behav., 32(3), 321-328.

Jordan, J.R., (2001). Is suicide bereavement different? A reassessment of the literature. Suicide Life Threat Behav.

3(1), 91-102.

Jordan, J.R. (2008). Bereavement after suicide. Psychiatric Annals, 38, 679-685.

Krysinka, K.E. (2003). Loss by suicide: A risk factor for suicidal behavior. J Psychosoc Nurs Ment Health Serv., 41, 34-

41.

Runeson, B., & Asberg, M. (2003). Family history of suicide among suicide victims. Am J Psychiatry, 160, 1525-1526.

Young, I.T., Iglewicz, A., Glorioso, D., et al. (2012). Suicide bereavement and complicated grief. Dialogues in Clinical

Neuroscience, 14(2), 177-186.

Page 23: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 23

IGL 102:

Beyond the Tears: Treating Complicated Grief

Eric Scalise, Ph.D. and Jennifer Cisney Ellers, M.A.

Page 24: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 24

Summary

Grief is a natural response to loss, but sometimes a person’s response to loss goes beyond the

typical and becomes complicated grief. Complicated grief can occur for a variety of reasons, and

can manifest differently in different people. In this presentation, Dr. Eric Scalise and Jennifer

Cisney Ellers share how to identify complicated grief. They also highlight risk factors and

treatment strategies for counselors seeking to more effectively help their clients.

Learning Objectives

1. Participants will define complicated grief and explore the prevalence of complicated grief

in America.

2. Participants will identify risk factors for complicated grief.

3. Participants will analyze treatment strategies for complicated grief.

Page 25: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 25

I. Complicated Grief

A. What Is Complicated Grief?

1. There is no one way to grieve, but in general the acute grief that occurs after a loss

starts to fade.

2. Some people remain in the acute stage of grief for a prolonged period of time.

3. Typically studies indicate that 10-20% of people experience complicated grief.

4. Nearly one out of every five of your clients may get stuck in the grief process.

B. Defining Complicated Grief

1. There is no current diagnosis in the DSM-5 for complicated grief.

2. Other terms for complicated grief:

Pathological grief

Prolonged grief disorder

Complicated bereavement disorder

Persistent complex bereavement disorder

C. Risk Factors for Complicated Grief

1. History of trauma and loss

2. History of mood or anxiety disorders

Page 26: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 26

3. Being a caregiver for the deceased

Caregivers feel responsible

Life is wrapped up with caregiving and suddenly it’s gone

4. Violent cause of death (homicide/suicide)

D. What Does Complicated Grief Look Like?

1. Inability to obtain closure

2. Difficulty speaking about the loss

3. Failure to fully face the reality of the loss

4. Disturbance of regular routines

Appetite issues

Sleep issues

5. Inability to let go

For a short time, this is normal

There are healthy ways and unhealthy ways to reflect and remember

6. Refusal to grieve and avoidance of loss reminders

People can have complicated grief that doesn’t manifest until years down the

road.

Page 27: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 27

II. Complicated Grief with Other Disorders

A. PTSD and Complicated Grief

1. The triggers of PTSD will make people avoidant

2. In order to grieve, people must remember

3. Sometimes complicated grief mimics PTSD

B. Complex Trauma and Complicated Grief

1. Not all trauma is the same, just as not all grief is the same.

2. Complex trauma can be created by a hostile or dangerous environment.

3. Complex trauma can set people up for complicated grief.

4. Complicated grief and trauma can influence the brain.

C. Treatment Issues

1. Making risk assessments is very important with complicated grief.

Suicide assessment

2. Medication doesn’t appear to be that helpful.

Medication helps depression, but not grief

3. Different types of therapeutic interventions are helpful.

Grief therapy helps more than basic CBT approaches

Page 28: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 28

4. Support groups can be a great supplement.

5. Internet-based resources and support groups can be very helpful.

6. People in complicated group tend to isolate so getting people in groups and

communities is healing.

III. DSM-5: Proposed Criteria for Persistent Complex Bereavement Disorder

A. Diagnostic Requirements

1. Symptoms lasting at least 12 months (six in children) following the loss of a loved

one

2. Persistent yearning /longing for the deceased

3. Preoccupation with manner of death

B. Six Additional Symptoms Required

1. Marked difficulty accepting that the individual has died or disbelief that the individual

is dead

2. Distressing memories of the deceased

3. Anger over the loss

4. Maladaptive appraisals about oneself in relationship to the deceased or the death

5. Excessive avoidance of reminders of the loss

Page 29: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 29

6. A desire to die to be with the deceased

7. Distrust of others

8. Feelings of isolation

9. Belief that life has no meaning or purpose without the deceased

10. A diminished sense of identity in which they feel a part of themselves has died or

been lost

11. Difficulty engaging in activities, pursing relationships or planning for the future

C. Is Recovery Possible?

1. It may take time, but healing is possible.

2. Post-traumatic growth can take place.

Page 30: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 30

IGL 103:

A Picture of Healing: Examples of Recovery from Loss

Jennifer Cisney Ellers, M.A.

Page 31: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 31

Summary

When people are in the midst of grief, it can sometimes appear that there is no end in sight.

However, there is hope – though the memories will never fade, the pain eventually will. In this

session, you will hear powerful testimonies of those who have loved, lost, and lived anew. Grief

may steal your joy for a time, but it does not have to last forever. Healing is possible.

Learning Objectives

1. Participants will be exposed to stories of grief and recovery.

2. Participants will explore how God can bring healing in the midst of tragedy.

3. Participants will be encouraged by testimonies of life and hope.

Page 32: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 32

I. What Does It Look Like to Grieve Well?

A. It Does Not Mean

1. Forgetting that the loss happened

2. Ceasing to miss the person

3. No longer longing for the day you’ll be reunited in heaven

B. It Does Mean

1. The pain changes

2. Moving on and fully embracing life

“Nothing can make up for the absence of someone whom we love. It is nonsense to say that God

fills the gap; God doesn’t fill it, but on the contrary, God keeps it empty and so helps us to keep

alive our former communion with each other, even at the cost of pain. The dearer and richer the

memories, the more difficult the separation, but gratitude changes the pangs of memory into a

tranquil joy. The beauties of the past are born not as a thorn in the flesh but as a precious gift in

themselves.”

– Dietrich Bonhoeffer

II. Stories of Hope and Recovery

A. Beth’s Story

1. Loss through foster care

2. Adopting

Page 33: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 33

B. Mark’s Story

1. The death of his best friend

2. Being there for his best friend’s widow and children

3. Sharing memories and stories

4. Creating a new family

C. Angela’s Story

1. Mother diagnosed with terminal cancer

2. Losing her baby to Trisomy 18

3. Faithfully Bold Movement

III. Conclusion

And we know that God causes all things to work together for good to those who love God,

to those who are called according to His purpose.

– Romans 8:28

Page 34: Complicated Grief, Loss, and Suicide 2.0: Finding … › mediaportaloutput.aacc.net › ...Complicated Grief, Loss and Suicide 2.0 Light University 5 Light University Established

Complicated Grief, Loss and Suicide 2.0

Light University 34

Copyright 2018 Light University

All Rights Reserved.

No part of this publication may be reproduced in any form without the expressed written

permission of Light University or the American Association of Christian Counselors.

Light University

P.O. Box 739

Forest, VA 24551

Member Services: 1-800-526-8673


Recommended