Complicated Grief: Cultural Considerations When Working ... · a significant cultural value for...

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Complicated Grief: Cultural Considerations When Working with Loss in Hispanic and Latino Students and Their Families

Transcript of Complicated Grief: Cultural Considerations When Working ... · a significant cultural value for...

Page 1: Complicated Grief: Cultural Considerations When Working ... · a significant cultural value for many Hispanic and Latino families, who need to feel connected and trust their therapist

Complicated Grief: Cultural Considerations When Working with Loss in Hispanic andLatino Students and Their Families

Page 2: Complicated Grief: Cultural Considerations When Working ... · a significant cultural value for many Hispanic and Latino families, who need to feel connected and trust their therapist
Page 3: Complicated Grief: Cultural Considerations When Working ... · a significant cultural value for many Hispanic and Latino families, who need to feel connected and trust their therapist

This publication was prepared for the National Hispanic and Latino MentalHealth Technology Transfer Center (NHLMHTTC) Network under acooperative agreement from the Substance Abuse and Mental HealthServices Administration (SAMHSA). All material appearing in thispublication, except taken directly from copyrighted sources, is in the publicdomain and may not be reproduced or copied without permission fromSAMHSA or the authors. Citation of the source is appreciated. At the time of this publication, Elinore F. McCance-Katz served as SAMHSAAssistant Secretary and Ibis S. Carrión-González, Psy.D Director of theNational Hispanic and Latino Mental Health Technology Transfer Center.The opinions expressed herein are the views of the authors and current staffof the NHLMHTTC and do not reflect the official position of the Departmentof Health and Human Services (DHHS), SAMHSA. No official support orendorsement of DHHS, SAMHSA for the opinions described in thisdocument is intended or should be inferred. For more information on obtaining copies of this publication visitmhttcnetwork.org/hispaniclatino or call 787-785-5220. Ibis S. Carrion–Gonzalez, PsyD – DirectorMiguel Cruz-Feliciano, PhD – Project EvaluatorIsa Velez-Echevarria, PsyD – Trainer and Content SpecialistDarice Orobitg, PhD – Training and Content ConsultantChristine Miranda, PhD – School-Based Trainer and Content SpecialistCarlos Barsy, MPsy – School-Based Trainer and Content ConsultantCindy Lou Negron–Matos, MA – Web and Social Media Content PublisherCarmen Andujar–Cantres, BA – Logistic and External Affairs Liaison

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esearch suggests that when aperson is exposed to the loss of a loved one in thecontext of violent circumstances including suicide,homicide or an accident, the most common griefresponse is known as complicated grief.Complicated grief is a prolonged form of grief thatcould interfere with normal functioning. The grieving process in children is different fromadults (Darman, 2011). Children need assistanceand guidance to cope with the emotions related tothe loss of a loved one (Lenhardt & McCourt,2000). If left untreated, complicated grief canpersist over time.

WHAT ISCOMPLICATED GRIEF?

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SYMPTOMS OF COMPLICATED GRIEFChildren can experience difficulties in acceptingthe death of a loved one. Children might expressdifferent emotional, physical, and psychologicalresponses, including anger, fear, withdrawal,illness, weight gain or loss, trouble sleeping,confusion, depression, and post-traumatic stressdisorder. Also, children might experiencebehavioral problems including acting out, hurtingoneself or others, running away, lack of motivationor other problems at school or in the community(Alvarez, 2011). Paying attention to these signs is essential inorder to help Hispanic and Latino childrenexperiencing complicated grief: p

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SadnessAnxiety focused on the loss of thedeceased and feelings of insecurityYearning or longingGuilt focused on regrets related tothe deceasedPreoccupying thoughts focused onthinking about the deceased Recurrent thought and imagesfocused on recalling memories ofthe deceasedSeeking proximity or wanting to beclose to the deceased personSuicidal ideation Avoiding situations, objects orplaces that evoke memories of thedeceased personDisturbed sleep and/or avoidanceof going to bed due to ruminationabout troubling aspects andmemories of the death

SYMPTOMS OF COMPLICATED GRIEF

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GRIEF AMONGHISPANIC ANDLATINOSAmong Hispanics livingin the United States arepeople from variouscountries like Mexico,Cuba, DominicanRepublic, Nicaragua,Colombia, El Salvador,Guatemala, Chile, Perú,and Puerto Rico amongothers. Even though theyare part of Latin America,each country has theirown cultural heritage,belief systems, norms,values and different waysin which first, second,and third generation ofimmigrants express andunderstand grief.

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Children may have difficulty sharing physical,emotional or psychological symptoms of distressas a result of some of these cultural norms. SomeHispanic and Latino children may believe that bynot showing their emotions, by displaying manlyattitudes, by not questioning, and by not becominga burden to their family, they are helping theirfamilies (Athan, 2014; Houben, 2012).Mental health providers need to be mindful abouteach student’s specific cultural values and socialnorms. Extended family members like cousins,grandmothers, uncles and aunts, could serve asuseful resources in helping mental health providersexplore the family traditions and values.p

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Familismo or familism is a culturalvalue that refers to the importance of family as theprimary system of support when a member of thefamily is in distress (North Carolina Healthy StartFoundation, 2008; Workgroup on AdaptingLatino Services, 2008). Engaging the survivingparent and family members in the therapeuticprocess, plays an active role in the counselingprocess of their children (Van Poppel, 2000). Personalismo or personalism, refers to theimportance of cultivating warm and caringrelationships over formal partnerships . This is alsoa significant cultural value for many Hispanic andLatino families, who need to feel connected andtrust their therapist in order to seek help for mentalhealth services (Hopkins, Huici & Bermudez, 2005,151). Therapists should also know that Hispanicand Latinos will often seek help initially for somaticsymptoms, rather than for mental health caresymptoms associated with grief (Alvarez, 2011;North Carolina Healthy StartFoundation, 2008).

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Respeto or respect, a strong cultural value thatprioritizes respect to elders in the family hierarchy,might play a vital role in the grieving process(Bougere, 2014). Often parents do not discuss withtheir children topics that are considered taboo,such as expressing how they feel about the loss ofa loved one. Awareness about this cultural valuecan help therapists to better understand how toadapt their therapeutic approach, so that it meetsthe needs of grieving children within Hispanic andLatino families.

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RELIGIOUS BELIEFSMany Hispanics embrace religion and spirituality atthe core of their lives. As part of their religiousbeliefs, the family may continue a relationship withthe deceased person through prayer, rituals, andtraditional practices. Mexican culture particularlyhas a holiday, known as Día de los Muertos toremember and honor those who have passedaway. In other Hispanic and Latino traditions,people create altars, use candles, and pray toremember their deceased loved ones.

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TIPS FOR

CULTURAL

CONSIDERATIONS

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Mental health professionalsand school personnel musttake in consideration cross-cultural differences if theywant to help alleviate thesuffering involved withgrieving. Counselors shouldbecome culturally competent,by using culturally adaptedcoping mechanisms andstrategies, to help grievingstudents cope with the deathof a loved one. Counselorscould encourage Hispanicand Latino children to sharetheir feelings with people theytrust and feel comfortablewith, to alleviate their burdenand to help them understandthat grief is a normal process,and they are not alone(Houben, 2012).

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Grieving therapy for helping Hispanic childrenshould incorporate the family, religious and culturalbeliefs, and the children level of acculturation(Arman, 2014). The implementation of grieving counseling forchildren is recommended to avoid long-termconsequences. Some options include:

Weekend Bereavement Camp Counseling,which teaches Hispanic children adaptive skills.The therapeutic approach addresses signs andsymptoms of complicated grief, and it isdelivered for eight weeks (once a week) amongchildren aged 7 to 10 years old (Alvarez, 2011).

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Family Bereavement Program was developed toassist children and families through the processgrieving (Murphey & Wahiba, 2012). Thistherapy uses modeling, role-playing, homeworkassignments, and collaborative group learningactivities. The family bereavement programprovides children and their caregivers withcoping skills.Grief and Trauma Intervention is based oncognitive behavioral therapy, narrative therapy,and expressive therapy. It was developed byHouben to help Latino children withposttraumatic stress disorder. The interventionincorporates art, drama, play, and culturallyrelevant approaches such as “death rituals,spiritual beliefs, coping strategies, historicaloccurrences and the child’s language” (Houben,2012).

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School personnel cancultivate more meaningfuland supportive relationshipswith Hispanic and Latinostudents by exploring,showing respect for, andacknowledging their culturalvalues. Hiring bilingual schoolpersonnel is the mosteffective way of overcomingthe language barrier ofcommunication if the primarylanguage of the student andfamily is Spanish. Schoolsmust also identify importantschool forms and documentsthat need to be translated intoSpanish, as yet anothercritical step to overcomethe language barrier thatfurther alienates Hispanic andLatino families from seekingemotional support.

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SCHOOL SETTING

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REFERENCES:

Alvarez, C. (May, 2011). A bereavement camp and support program for Latino childrencoping with the loss of a parent: A grant proposal. Long Beach, CA: California StateUniversity. Retrieved from http://pqdtopen.proquest.com/pqdtopen/doc/887995023.html?FMT=AIArman, J. F. (March, 2014). A Grief Counseling Group Design for Hispanic Children.Retrieved from https://www.counseling.org/docs/default-source/vistas/article_69.pdf?sfvrsn=d6117e2c_10Athan, L. (2014). Grief speaks. Retrieved fromhttp://www.griefspeaks.com/page/talkingto-children-about-grief-id5htmBougere, M. H. (2014). Culture, grief, and bereavement: Applications for clinicalpractice. Minority Nurse.com. Retrievedfrom http://www.minoritynurse.com/article/culture-grief-and-bereavement-applications-clinical-practice Darman, E. (30 October 2011). Children’s reaction and adjustment to parentaldeath. http://en.rawanonline.com/childrens-reaction-adjustment-to-parental-deathHopkins, S., Huici, V., & Bermudez, D. (2005). Therapeutic play with Hispanic clients.In E. Gil & A. A. Drewes (Eds.), Cultural issues in play therapy (pp.148-167). NewYork/London: The Guilford Press. Houben, L. M. (2012). Counseling Hispanics through loss, grief, and bereavement: Aguide for mental health professionals. New York, NY: Springer Publishing Company. Lenhardt, A. M. C., & McCourt, B. (2000). Adolescent unresolved grief response to thedeath of a mother. Professional School Counselor, 3, 189-197.Murphey, D., & Wahiba, B. (2012). The family bereavement program (FBP). ChildTrends. Retrieved from http://childtrends.org/?programs=the-familybereavement-program-fbpNorth Carolina Healthy Start Foundation. (March, 2008). Understanding bereavementin Latino families: A practical guide for practitioners. Maternidad Latina, 2(2). Retrievedfrom http://www.nchealthystart.org/aboutus/maternidad/vol2no2.htmVan Poppel, F. (2000). Children in one-parent families: Survival as an indicator of therole of parents. Journal of Family History, 3, 269-290.Workgroup on Adapting Latino Services. (2008). Adaptation guidelines for servingLatino children and families affected by trauma (1st Ed.). San Diego: Chadwick Centerfor Children and Families. Retrieved from http://chadwickcenter.org/ WALS/wals.htm

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