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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

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Withdrawn from friends, family, activities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