Crisis Intervention

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Grief is a multi-faceted response to loss.-multifaceted; there are many aspects when dealing

withgrief.

Grief is a profound emotional crisis.-it is profound because it is enormously complex andrelated to a wide array of circumstances.

-it is a crisis because it brings one to the necessity of

decisions (Carse, pg.3)

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Grief is a state in which the bereaved person has lost someone or something of personal value.

Grief is a time when individuals experience major physical, emotional, and cognitive changes.

It must be dealt with, and because it is profoundly complicated, it must be dealt with in a fundamental manner (Carse, pg. 3).

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According to John Bowlby’s attachment theory, the meaning of attachment furthers our ability to comprehend grief.

Continual attachments to others are formed.

Attachments develop from needs for security and safety, which are acquired through life, and directed towards a few specific individuals.

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The goal of attachment behavior is to form and maintain affectionate bonds, throughout child and adulthood.

Bowlby proposed grief responses are biologically general responses to separation and loss.

Behavioral responses making up the grieving process are pro-survival mechanisms geared towards restoring the lost bonds (Worden, pg. 12)

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According to Barbato & Irwin, it is described that the vast repertoire of grieving behaviors are categorized as the following:

- Emotional Response

- Physical Sensations

- Cognitive Responses

- Behaviors (Barbato and Irwin, pg. 22)

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Grief is fundamentally an emotional response to loss, the expressions can include the following:-sadness, sorrow, fatigue, depression, relief, shock, anger, guilt, anxiety, sleep and appetite disturbances.

Intense feelings of loneliness and isolation, following the death of a loved one, can sometimes become so overwhelming that the bereaved may withdraw from social contact, which may mean isolating themselves from support (Barbato & Irwin, pg 23). 7

Anger is a frequently experienced emotion following the loss, the anger may be directed at the deceased for leaving .

If not addressed, complications will soon arise, and anger will be directed towards others through blame.

Grief not only elicits emotional disturbances, but also physical symptoms such as;

-tight feelings in the throat and chest-over sensitivity to noise-breathlessness-muscular weakness-lack of energy

Feeling this way is normal when one is going through the grieving process, they are usually transitory, and may sometimes become a concern (Barbato & Irwin, pg. 23).

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Disbelief is often the initial cognitive reaction to the news of a death, especially if the death was sudden.

Transitory, but it can persist and become denial where the bereaved does not accept the death.

Other cognitive responses include feelings of confusion, difficulty organizing thoughts and preoccupation with the deceased.

The bereaved person may report a sense of presence of the deceased and may think that the deceased is still around (Worden, pg. 31).

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The most commonly reported behaviors include: -sleep disturbance-altered appetite (over/under eating)-absent mindedness-social withdrawal-dreams of the deceased-avoidance behavior-restlessness-searching or calling out for the deceased-crying, which is believed to relieve emotional stress

(Worden, pg. 37)

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Mourning is a process, not a state of mind, and as in any process, work is done so that the process can proceed to successful finalization.

There are four tasks to mourning , which may take place in any order (Worden, pp.101-104).-Task 1: Accepting the reality of the loss

-Denying the fact of the loss.- Denying the meaning of the loss.-Denying that death is irreversible.

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Task 2: To work through the pain of grief.

Task 3: To adjust to an environment in which the deceased is missing .

Task 4: To emotionally relocate the deceased and move on with life (Worden, pp. 101-104)

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Complicated bereavement is the intensification of grief to a level such the person feels overwhelmed, resorts to maladaptive behavior, or remains interminably in a state of grief without progression of the mourning process towards completion.

Normal and complicated mourning are on a continuum, with extremes of effect, intensity and time scale determining pathology, rather than the presence of any one particular symptom

(Worden, pg, 115).

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Normal process of mourning can turn to complicated mourning for a number of reasons;

-difficult circumstances surrounding death -a person’s history of grieving experiences-the personality of the bereaved person-social factors

Childhood Bereavement

Death of a child

Death of a spouse

Death of a parent

Death of a sibling

(http://en.wikipedia.org/wiki/Grief)

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Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions.

Social workers should inform the bereaved that the goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence.

Example, identifying which of the grief tasks have not been resolved and working through them with the person.

If the social worker believes that a previous death may still be lingering with the current death, helping the bereaved to explore the past relationship may resolve the current problems (Worden, pg. 130)

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When helping someone deal with the loss of a loved one the social worker should:-assess the impact of loss the deceased has on the

bereaved-be informed about the available formal and informal

resources to help minimize grief and isolation from family, friends and supporters

-be aware of their own feelings about death, dying, and the grieving process, so that they may become more comfortable being physically and emotionally present with clients and their loved ones

-identify literature, cultural experiences, and other ongoing education about the ways in which your client(s) deal with death. Remember, the client may be your best teacher (Hutchinson, pg.450)

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Denial-”I feel fine.” “This cannot be happening to me.”

Anger-”Why me? It’s not fair!”

Bargaining-”I’ll do anything, can you stretch it out just a few more years.”

Depression-”I’m so sad, why bother with anything?”

Acceptance-”I can’t fight it, I may as well prepare for it.” (www.yahoo.com)

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Barbato, A., & Irwin, H., (2004). Major therapeutic systems and the bereaved client. Australian Psychologist, 27, 22-27.

Carse, J., (1981). Grief as a cosmic crisis. Acute Grief. Columbia University Press: New York.

Hutchinson, E., (2008). Dimensions of Human Behavior: The Changing Life Course. (3rd ed.) Thousand Oaks, CA: Sage Publications, Inc.

Walsh, J., (2006). Crisis Assessment and Intervention. Theories for direct social work practice. Brooks/Cole: Belmont, CA.

Worden, J.,(1991). Grief Counseling and grief therapy: A handbook for the mental health practitioner. (2nd ed.). London: Springer.

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