PROMOTING EDUCATION & AWARENESS OF LONG-TERM GRIEF COMPLICATIONS
There are various ideas regarding how these conditions (CG/PCBD) can be defined, ways they can be diagnosed and the different means by which they can be treated. Although these ideas differ somewhat significantly in terms of the factors described there are often broad similarities.
Grief is a phenomenon deeply personal to any individual and the situation and circumstances of any one particular case can be highly specific. Therefore, it's important to concede that there is no such thing as a 'one size fits all' regarding types of treatment.
WHAT TO DO IF YOU THINK YOU HAVE CG/PCBD
Do your own research
Investigate different types of grief complications by researching on the Internet as well as sources such as resource libraries and agencies involved in providing care to the bereaved. Primary and secondary (even tertiary) sources can all be useful when attempting any degree of initial self-diagnosis.
Speak to family, friends, colleagues, neighbours and other people whom you trust
Relevant social support networks consisting of family members, friends, colleagues, neighbours and other acquaintances can be very significant in dealing with both normal grief and grief with complications. Talking can help to verbalise thoughts and feelings, to share problems and concerns and to begin to frame issues that may seem insurmountable. Voice your concerns with people that you know and trust and who will treat what you say to them with sensitivity and respect.
Speak to bereavement support agencies for help and support
There are a number of agencies that provide guidance and advice as well as requisite help and support for people experiencing the effects of bereavement. Many of these specialise in providing care to people suffering certain types of loss and have trained and experienced staff to offer appropriate assistance. They can usually be contacted by whatever means are comfortable for you, either by phone, email, social media and/or in person.
Find a Bereavement Support Group
This can be facilitated in some cases via a Bereavement Support Agency. It is often possible to access these by means of direct referral. They may be particularly useful for people who have certain support needs based on various types of bereavements and losses, some of which can involve specialised forms of care and support.
Find an On-line Bereavement Forum
This can also be facilitated in some cases via a Bereavement Support Agency. In cases where a local support group is unavailable and/or inaccessible an on-line forum can be particularly useful.
Speak to your GP regarding Mental Health Services
Access to interventions such as those offered by the NHS can be facilitated through your GP/Doctor. These will include a range of services that address various aspects of mental health care. Self-referral is possible in some cases e.g. Improved Access to Psychological Treatments (IAPT).
Contact a recognised Counsellor/Therapist
A number of agencies may be used to facilitate and establish contact with trained and qualified counsellors who have relevant skills and experience.
For more information please see the Useful Contacts LINK:
The following are examples of interventions that can be useful to people suffering from CG/PCBD:
PHYSICAL EXERCISE: AEROBIC/ANAEROBIC/SELF-STYLES:
Relaxation Exercises / De-stressing Techniques e.g. Visualisation
Homoeopathy e.g. Aromatherapy, Massage
PSYCHOLOGICAL & THERAPEUTIC INTERVENTIONS:
In addition to the above, the treatment of CG/PCBD can involve a range of psychological and therapeutic interventions. Although this is a burgeoning area of research there is still relatively little documentary evidence available regarding the effectiveness of treatments for CG/PCBD.
In recent years, there has been considerable research on the treatment of 'complicated' grief. Treatments can be broadly categorised according to their development by three main research groups, each of which uses a somewhat different heuristic model (Katherine Shear et al 2011). These are i) Cognitive-Behavioural Therapy (CBT), ii) Complicated Grief Treatment (CGT) and iii) Meaning Reconstruction Theory.
Cognitive-Behavioural Therapy (CBT)
Cognitive-Behavioural Therapy (CBT) is a problem-focused and action-oriented form of therapy that targets challenging and changing unhelpful cognitive distortions i.e. thoughts, beliefs, attitudes and behaviours as well as addressing emotional regulation. Cognitive Behavioural Therapy tailored towards grief has shown some success in assisting individuals with grievous complications, especially in comparison with non-specific or supportive therapies (Paul Boelen et al 2007, Wittouck et al 2011). Randomised controlled trials with various demographics have suggested the efficacy of CBT including an exposure component that is targeted on long-term grief complications as in the case of Complicated Grief Therapy CGT (Katherine Shear et al 2005, Katherine Supiano & Marilyn Luptak 2014, Birgit Wagner et al 2006).
Complicated Grief Treatment (CGT)
Complicated Grief Treatment (CGT) is a relatively new psycho-therapeutic model designed to address symptoms associated with grief complications. Drawn from Attachment Theory and with roots in both Inter-personal Therapy (IPT) and Cognitive-Behavioural Therapy (CBT), CGT includes techniques similar to prolonged exposure (repeatedly telling the story of the death and in vivo exposure activities). The treatment also involves focusing on personal goals and relationships in the context of long-term bereavement.
Meaning Reconstruction Theory
Meaning Reconstruction Theory (Robert Neimeyer 2006, Robert Neimeyer & Carol Wogrin 2008, Robert Neimeyer 2016) is a ‘cognitive‐constructivist’ approach to grief, which suggests the relevance of meaning‐orientation, narrative strategies and auto-biographical memory in adapting to bereavement. Therapeutic work involves a) processing the ‘event story’ of the loss and its implications for the survivor’s life and (b) accessing and affirming the ‘back story’ of the relationship with the deceased.
Due to their distinct methodological approaches the models as well as the treatments have many similarities and differences and these may be effectively integrated as well as demonstrated in relation to given case studies (Rita Rosner et al 2011, Julie Wetherell 2012).
Since CG/PCBD remain as much socio-cultural phenomena as distinct grief pathologies it indicates that there is a significant amount of work to be done in terms of drawing connections between these states and considering ways in which grief and its myriad complications become embedded in society, culture and life-history (Paul Rosenblatt 2013). Dimensions of control with respect to therapeutic interventions may also be significant e.g. the pathologisation of grief in contemporary society and the ways that this is engendered (Ian Craib 1998).
A major issues is that many of the above therapies, specifically designed to treat grief complications, are not widely available in the UK.
OTHER PSYCHOLOGICAL THERAPEUTIC APPROACHES:
In addition to these approaches there are a range of therapeutic interventions that may also be used in the treatment of grief complications. Since this is not a widely understood condition the type of therapy that is accessible might be more generically geared towards simple grief rather than specifically directed towards any of its more complicated responses.
Integrated Supportive Counselling
Grief counselling is usually appropriate to the persons dealing with normal grief although it may be extended to those experiencing CG/PCBD. The major goal of grief counselling is to help the bereaved to successfully accomplish the tasks in the grieving process by working through various aspects of the loss and trying to come to terms with the reality of the death and the effects it has caused.
Interpersonal psychotherapy, in particular CG/PCBD targeted psycho-therapy may also be useful in treating both the symptoms and causes of the condition.
Narrative Therapy/Narrative Reconstruction
Narrative Therapy and Narrative Reconstruction can both be used to recount various aspects of death, bereavement, loss and grief (Michael White & David Epston 1990).
The use of art therapy can be used with people suffering from grief issues including CG/PCBD and can have remedial outcomes (Diane Kirkpatrick 2017).
Exploring issues regarding bereavement and loss through the medium of drama workshops can be especially useful in terms of relating to grief and grievous issues through 'acting out', 'rôle play' and the use of real/imaginary contexts.
If you suffer from Complicated Grief/Persistent Complex Bereavement Disorder then therapeutic interventions may be helpful to you. However, it's important to prepare yourself for what therapy might entail:
-Both getting ready and being ready for therapy are really important. Before you decide on any type of therapeutic intervention begin by considering whether its right for you, based on your own situation and circumstances. It has to be the right type of therapy, the right therapist, the right time and the right place. Most importantly it has to be for you and because you both want and need to do it. Don't do therapy for somebody else, first and foremost do it for yourself.
-Seek advice from qualified therapists regarding the type of therapy that may be best suited to you and your own particular needs. What is suitable to one person might not be suitable to another.
-Therapy can involve an often significant financial cost. The type of therapy that you undertake should not only be appropriate to your needs it should be within your means to afford without causing undue hardship.
-Make consistently well informed decisions regarding your therapy, including the type(s) of therapy and the therapist(s). Bear in mind time schedules, accessibility of location, integrating with other work/study/personal commitments. It's important not to set yourself up to fail so give yourself every opportunity of getting to therapy and remaining on track with it.
-Interventions/treatments may be non-linear i.e. these activities can often be less than straight-forward involving breaks and changes as well as different types of progress. Life sometimes gets in the way of therapy, however, if you believe in your therapeutic interventions and are invested in them then you'll do what you need to do in order to make them a priority in your life.
-A significant aspect of therapy is confronting memories and feelings that are often extremely painful and sensitive. A major component of dealing with grief complications is approaching, challenging, negotiating and processing the memories and feelings associated with it. It involves an often high degree of 'emotional work' that will require you to go deep and explore sentiments in ways that you maybe hadn't previously.
-Therapeutic interventions/treatments should be considered as 'long-term measures' rather than 'short-term fixes'. The more prolonged the period of grieving the greater the number of potential complications may exist. These are likely to take a significant length of time to work through and sessions will usually require moderate to high levels of input in order to get the most out of them.
-Unless you intervene on your own behalf it is highly unlikely that anybody else will. You are responsible for organising your own therapy (with help from others wherever appropriate). Have the courage to take the first step, commit to your treatment(s) and do your best to work through them with the type and level of support that you need.
Note that co-ordination of care is highly important:
It is highly advisable to make everyone who is involved in your care delivery fully aware of the type of treatment/therapy that you are seeking and receiving (Craig White 2013 p.12). Therapies cannot and should not be be taken without due advisement from qualified and experienced therapist(s) involved in delivering these interventions. Also be sure to communicate this to others whom you trust so that they know what's happening.
Ultimately you are responsible for your seeking your own form(s) of treatment and for making informed choices and decisions regarding that treatment. These may need to be continuously re-assessed, depending upon the type of therapy that you are undertaking and/or any changes to your personal circumstances. Any such factors, regardless of how inconsequential they may seem, might have bearing on your therapy.
For more information on Living & Coping please use the following LINK:
Please note that the information presented on these web-pages is not a substitute for medical advice or for seeking professional help through therapy and/or other forms of treatment.
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Craib, Ian, (1998), ‘What’s Happening to Mourning’ in Social Theory: Experiencing Identity (pp.157-167)
Granek, Leeat (2010), Grief as pathology: The evolution of grief theory in psychology from Freud to the present, History of Psychology, 13, pp.46-73
Granek, Leeat (2014), 'The Complications of Grief: The Battle to Define Modern Mourning' in Miller, Eric (Ed) (2014), Stories of Complicated Grief: A Critical Anthology
Washington DC (US): NASW Press
'Is Mourning Madness' by Leeat Granek & Meghan O'Rourke, Slate Magazine, Posted 12th March 2012 http://www.slate.com/articles/life/grieving/2012/03/complicated_grief_and_the_dsm_the_wrongheaded_movement_to_list_mourning_as_a_mental_disorder_.html?via=gdpr-consent
Jackson, Teresa (2017), Loss Of A Parent: Adult Grief When Parents Die
Kirkpatrick, Diane (2017), Grief and loss; living with the presence of absence. A practice based study of personal grief narratives and participatory projects. PhD, University of the West of England
Neimeyer, Robert, 'Complicated grief and the reconstruction of meaning: Conceptual and empirical contributions to a cognitive‐constructivist model', Clinical Psychology: Science and Practice 13(2): pp.141-145, 2006
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Schupp, Linda (2007), Grief: Normal, Complicated, Traumatic
Eau Claire, WN (US): Pesi Publishers
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