Download - How to Use Narrative Therapy in Complicated Grief Counseling · Issues and Concerns of Complicated Grief •Severe impairment in functioning (Mayo Clinic, 2014) •Strained personal

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.




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• Withdrawn from friends, family, activities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



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. (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


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.

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


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. (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.

