1. Understanding Grief: Assessment and Treatment Planning Karen Horinek, L.C.P.C. Bereavement Coordinator/Counselor And Terra Solove, M.S.W. Bereavement Counselor

2. What is Grief? Grief is the physical, emotional, somatic, cognitive and spiritual response to actual or threatened loss of a person, thing or place to which we are emotionally attached. We grieve because we are biologically willed to attach. (John Bowlby, Father of Attachment Theory) Grief is the physical, emotional, somatic, cognitive and spiritual response to actual or threatened loss of a person, thing or place to which we are emotionally attached. We grieve because we are biologically willed to attach. (John Bowlby, Father of Attachment Theory)

3. Common Grief Responses Feelings Numbness Numbness Shock Shock Anger Anger Anxiety Anxiety Loneliness Loneliness Fatigue Fatigue Yearning Yearning Relief Relief

4. Common Grief Responses Physical Sensations Tightness in the chest Tightness in the chest Shortness of Breath Shortness of Breath Lack of Energy Lack of Energy Panic Attack-like symptoms Panic Attack-like symptoms

5. Common Grief Responses Cognitions Disbelief Disbelief Confusion Confusion Sense of Presence Sense of Presence Lack of Concentration Lack of Concentration

6. Common Grief Responses Behaviors Sleep disturbances Sleep disturbances Appetite disturbances Appetite disturbances Social withdrawal Social withdrawal Dreams of the deceased Dreams of the deceased Absent-minded behavior Absent-minded behavior

7. Common Grief Responses Cultural Differences Cultural Differences Gender Differences Gender Differences

8. Differences between Grief and Depression Depression shares common features with grief. Misdiagnosis can result in overlooking depression when it is present and inappropriately treating grief. American Family Physician Article (www.aafp.org/afp/20020301/883.html)

9. Assessing between Grief and Depression Grief Experienced in waves Experienced in waves Diminishes in intensity over time Diminishes in intensity over time Healthy self-image Healthy self-image * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Moods and feelings are static Moods and feelings are static Consistent sense of depletion Consistent sense of depletion Sense of worthlessness and disturbed self-image Sense of worthlessness and disturbed self-image

10. Assessing between Grief and Depression Grief Anhedonia Anhedonia Hopelessness Hopelessness Response to support Response to support Overt expression of anger Overt expression of anger * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Anhedonia Anhedonia Pervasive hopelessness Pervasive hopelessness Unresponsive to support Unresponsive to support Anger not as pronounced Anger not as pronounced

11. Assessing between Grief and Depression Grief Guilt is focused on aspect of loss Guilt is focused on aspect of loss Not demoralizing or humiliating Not demoralizing or humiliating Preoccupation with deceased Preoccupation with deceased Suicidal gestures rare in uncomplicated grief Suicidal gestures rare in uncomplicated grief Elicits sympathy, concern and desire to embrace Elicits sympathy, concern and desire to embrace * Excerpts from Therese A. Rando (1993).Treatment of Complicated Mourning. Research Press, Champaign, IL. Depression Guilt is preoccupied with a negative self-image Guilt is preoccupied with a negative self-image Demoralizing and humiliating Demoralizing and humiliating Preoccupation with self Preoccupation with self Suicidal gestures not unusual in depression Suicidal gestures not unusual in depression Elicits irritation, frustration and a desire to avoid Elicits irritation, frustration and a desire to avoid

12. Grief Assessment What was the relationship What was the relationship Nature of the Attachment Nature of the Attachment Mode of Death Mode of Death Historical Antecedents Historical Antecedents Personality Variables Personality Variables Social Variables Social Variables * Adapted from William Worden. (1982). Grief Counseling and Grief Therapy. New York: Springer Publishing Company

13. Theories on Bereavement Elizabeth Kubler-Ross: Stages Elizabeth Kubler-Ross: Stages William Worden: Four tasks of grieving William Worden: Four tasks of grieving Robert Neimeyer: Rebuilding life and search for meaning Robert Neimeyer: Rebuilding life and search for meaning

14. Treatment Planning Establish a relationship with the bereaved Establish a relationship with the bereaved Be comfortable with their expression of grief Be comfortable with their expression of grief Listen Listen Normalize grief reactions Normalize grief reactions Companion them in rebuilding their life Companion them in rebuilding their life

15. Taking Care of Myself Know your own limits Know your own limits Set boundaries Set boundaries Nurture yourself Nurture yourself