• Depression in this case is considered “normal” but individual my be seeking treatment to relieve symptoms such as insomnia or anorexia.
• Expression of “normal” bereavement time is relative to different cultures.
• Major Depressive disorder is not diagnosed unless symptoms last longer than two months after loss.
Stages of Grief:
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
Reactions commonly seen in children:
o Disbelief- children may act as if it did not happen.
o Complain of headaches, stomachaches, or fear of their own death.
o Anger- concern over own needs and about being alone, or with God.
o Guilt- feelings of causing death, or not having been “better”
o Anxiety/Fear: may become clingy and need validation of love.
o Regression: revert to bed wetting or thumb sucking
o Sadness: lethargy and isolation
Short Term Treatment Goals
• Express fear and anger, grieve in a healthy way.
• Loss and Grief Counseling Group
• Recall fond memories
• Create a phone list of supportive people to call
• New coping techniques
• Find a “safe place” to spend limited time thinking about deceased
• Exercise regiment
• Relaxation techniques- progressive muscle relaxation, guided imagery
Long Term Treatment Goals
• Reach a point of coping without being overcome with grief.
• Regain normal activity.
• Reduce feelings of guilt and anger towards self, others, and God.
• Re-mature over regressed behaviors
• Understanding of death and life.
Therapeutic Interventions
• Writing Activities
o Letter to deceased for closure
o Journal of thoughts (may be shared in counseling, in group, or with family members)
• Art therapy:
o Finger paints are useful in expressing feelings
o Draw pictures of activities enjoyed with deceased (useful with children).
o Collage on a theme
o Splatter room: area where (particularly children) are free to throw violent splotches of paint to get anger out.
• Play Therapy:
o Model clay or dough to vent anger or create ritual objects
o Puppetry- to express feelings
o Sand tray to play out themes, “burry” deceased for closure, or rake sand for relaxation or meditation.
• Bibliotherapy:
o Appropriate self help books
o Books related to symptoms client is displaying
• Loss Graph or Timeline:
o Used to discuss types of loss
o Used to recall fond memories and celebrate life
• Storytelling:
o Fantasy monologues
o Mutual storytelling
• Therapeutic Metaphors
o Helpful in understanding concept of death
• Empty Chair
o Gestalt technique
o Imagine deceased in chair and speak to them for closure
