Personal Guidebook to Grief Recovery

Transform Grief

With Transform Grief you will get a systematic approach to replacing your grief with newfound happiness. Heres how: Your first step will be to gain the understanding that it is okay to start feeling better. Grief oftentimes makes us feel shame for being happy and through this introduction you will understand that your loss doesnt mean you have to mourn for your own life. Understand the 7 stages of grief and how you can navigate them in a healthy and productive manner. Conventionally, there have always been 5 stages of grief but this adaptation will provide you with the vital turning points experienced in the journey. Forgiveness is often overlooked when discussing grief, you will discover why and how you can forgive yourself, forgive others and most importantly, forgive the situation that got you here. Forgiveness is for you and it stands in the way of your ultimate happiness you need to move on with your life. Identify the facets of your support system that will carry you back to life as you once knew it. The smile on your face will return as joy and enthusiasm become possible again. Discover the 10 powerful actions that will help you deal with your grief in a constructive and helpful manner. Each exercise in this section will bring you one step closer to the peace you strive for. Its just one foot after the other towards resolution. Youll find out the two most important questions to answer in your grief circumstance and those answers will guide you to the finish line a world that your love every moment living in. Read more...

Transform Grief Summary


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Contents: 32 Page Ebook, Videos, MP3 Audios
Author: Jason Ellis
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Highly Recommended

This is one of the best e-books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

As a whole, this manual contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Definitions Of Bereavement Grief Mourning

The term 'bereavement' is derived from the Anglo-Saxon word bereafian, which means to be robbed. The sense of a love and life taken resonate through literature and the narratives of bereaved people. The sense of emptiness is a common experience. A study day on perinatal loss was entitled 'The Aching Void'. The term 'grief' is often used to describe the emotional experience of loss but it is understood more widely as being not only the affective experience but also the cognitive, physical and behavioural changes that accompany it. C.S. Lewis (1966) describes the autonomic experience 'No-one told me that grief felt so much like fear . . .' The type of emotional reaction may be unexpected but bereaved people do expect to feel upset. Fewer anticipate the temporary loss of concentration and memory and 'Mourning' was used by Freud to mean what is now understood as 'grief' but the term 'mourning' has come to mean the rituals associated with the expression of grief and is socially determined...

Grief counseling

Grief counseling refers to a specific form of therapy, or a focus in general counseling with the goal of helping the individual grieve and address personal loss in a healthy manner. Grief counseling is offered individually by psychologists, clergy, counselors or social workers, in groups led by professionals, as well as informal support groups offered by churches, community groups, or organizations devoted to helping individuals grieve specific losses. Specific tasks of grief counseling include emotional expression about the loss (which can include a wide range of feelings), accepting the loss, adjusting to life after the loss, and coping with the changes within oneself and the world after the loss. Typical feelings experienced by individuals, and addressed in grief counseling, include sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness. Behavioral changes may also be noticed, such as being disorganized, feeling tired, having

Processing grief

Folkmans Model Grief

So far the coping response has referred to the management of fear and anxiety. The different ways of processing of grief will now be discussed. In processing grief there is a similar pattern to that seen in the management of anxiety. Some individuals process their grief and move towards resolution others have a prolonged experience or get stuck at a particular point. These two paths parallel the mature and defensive management of anxiety whilst in the symptomatic group individuals become very depressed. The terminology usually used to describe these different patterns with respect to grief is normal, atypical or chronic and symptomatic. Grief is the experience of loss, a long process where the central task is the ability to say goodbye and mourn the loss. Mourning is the process that has to be gone through in adapting to the loss. The term bereavement usually is The genetic counsellor will be very familiar with the grieving process as there are many different forms of loss around...

A problemsolving approach

Listen to the problem of first presentation this involves listening not only to issues, events and experiences, but also to the patient's feelings and distress. The emphasis here is more on the communication skills of facilitation, silence, clarification, reflection, paraphrasing, confrontation and summary, than on questioning. In many cases this phase of the counselling constitutes the major part of the therapy e.g. in grief or bereavement counselling, where the doctor supports the patient through a natural but distressing process.

Toward Ethical Guidelines Of Terminal Care

The dying person should be given the opportunity, when possible, to share in planning for changes that death will impose on the survivors. Attending persons should assist in making resources available for planning by the patient and for sharing concern for the relatives, both during the process of dying and after death. Such planning could include planning for the distribution of one's estate, discussing how decisions will be made in later stages of care if one becomes decisionally incapacitated, and sharing the concerns of relatives and their futures. Care should always be extended to the family and not just to the terminally ill patient, and this should include the grieving process. Families should not be cut off from care once the patient has died. Hospice programs have attempted to provide a place for families after the death of the patient, including grief counseling acute-care institutions have not.

Methodological Issues

Some deaths are sudden but even where there has been a period of forewarning it may be seen as sudden by those bereaved. Anticipatory grief was described by Lindemann (1944) and the concept was refined by Rando (1988). The term originated to describe the experience of grieving so fully before an expected death that emotional ties are relinquished - the missing soldier returns but finds no welcome. A different view is that attachment strengthens in the face of loss and anticipatory grief is not the same as the grief felt subsequently. A preparatory period can offer advantages but if the final illness is of a protracted and uncertain duration then this brings different stressors. A study of 73 caregivers bereaved by the death of an elderly relative identified that quality of support prior to the death was more important in adjustment to bereavement than subsequent support (Bass, Bowman & Noelke, 1991). For a parent there is an untimeliness about the death of a child whether that child...

The Effectiveness Of Interventions

Reviews of the effectiveness of bereavement intervention do not indicate a strong evidence base for much current clinical practice. The methodological flaws described at the start of the chapter have resulted in few studies that meet the criteria set by reviewers. Schneiderman et al. (1994) found only four articles out of 53 published that satisfied their criteria. These four studies had conflicting results and the authors concluded there was little sound evidence for or against bereavement programmes. Both a qualitative and quantitative approach was used by Kato & Mann (1999) in an analysis of 13 adult studies that met their criteria, including random allocation to intervention and control groups. They concluded that there was little strong evidence that intervention was effective. Small effect sizes only were found and theory and practice were not clearly linked in the research. The relevance of bereavement research to clinical practice is questioned by Allumbaugh & Hoyt (1999) who...

Depression in Older Patients

Major depressive disorder is frequently undiagnosed and untreated in older patients, and can be associated with high morbidity and mortality in this patient group, who are particularly prone to completed suicide or self-neglect. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Comorbid medical conditions, including cardiovascular events, stroke, vascular dementia, and Alzheimer's disease, which are common among older patients, can have a significant impact on depression, and vice versa.

Dysmorphology clinics

This analysis of the four different genetic disorders has shown how the educational intervention is common to all but, in each disorder, it is slanted to take into account the significance of the disorder and the impact of a diagnosis or test result. Psychological interventions are also necessary and are again related to the particular disorder and the individual. Grieving and containment of anxiety are common to all disorders but each disorder triggers a particular psychic pain and necessitates the counsellor be sensitive to the difference. Where there are prenatal problems the counsellor is mindful that the educative information presented needs to give as accurate and objective view of the foetus as possible. This helps redress any mispercep-tions based on fear or denial, as it will be an important factor in the decision about the future of the pregnancy. In Huntington's disease the emphasis is on exploring the significance of the diagnosis and the motivation for testing in the...

Psychosocial Factors Involved In Hair Cosmetics

Haircare and psyche reciprocally reflect each other both positively and negatively (bad hair days). Contrary to the bad haircare and negligence of a depressed person or a man in grief, generally people tend to offer themselves the best of haircare when they are feeling happy or when they want to show their internal feelings to others through body language. This is particularly obvious during public appearances and important social gatherings (e.g., parties, marriage ceremonies). Haircare by itself can induce a state of self-confidence and may reflect social status. This may explain significant differences in shampooing regimens, which range from once or twice a week to once a day.

Other emotions frequently experienced in genetic counselling

That the feelings need to be explored and put in the context of the individual's history and psychological make-up. In addition it may be useful to consider whether excessive guilt is part of a grieving process which has become stuck and needs to be unlocked. This can be done by refocusing on any loss which has not been fully acknowledged and helping the individual move along the path of grief. Guilt can also be a cover for anger or indeed exist because of angry feelings. Alternatively, guilt is easily triggered in the 'perfectionist' and can be experienced as a punishment for some minor or major misdemeanour. It is worth remembering that, if these feelings have arisen in the context of disappointment and grief, then they could be considered to be part of a 'blocked' grief process. Consequently, if the counsellor offers an understanding relationship, the individual, or couple, may be able to leave behind the punitive feelings of guilt and shame and work through their sadness.

Legal Remedies as a Result of Being Involved in a Single Life Threatening Situation

That said there appears to be two important aspects to determine whether liability should be imposed. First, the injury alleged must be a recognised psychiatric disorder that is more than a claim purely for a temporary upset such as grief or distress or fright from which we all suffer at times (Hinz v. Berry, 1970 cf. Tredget v. Bexley Health Authority, 1994). Examples of psychiatric illness would include clinical depression, personality changes, PTSD. Second, the person claiming the psychiatric harm must fall within a category accepted by the courts as being entitled to claim. This latter restriction may present difficulties for the 'professional' rescuer, such as a police officer, as we shall see shortly.

Secure base and individual behaviour

In contrast, when the mother's attunement is insufficient, or is inaccurate, the secure base is not established. An insecure attachment is then established and the difference between the two is reflected in the behaviour of the child on separation and, more generally, how emotions are regulated. A child who has experienced a secure attachment can tolerate separation and work through its accompanying anxiety and grief, whereas it is more problematic for those who have an insecure attachment pattern. Ainsworth et al.'s (1978) contribution to attachment theory was their invention of the 'strange situation'. In this experiment they observed the behaviour of young children on separation from the mother and related it to the attachment experience. This enabled a classification of secure or insecure attachment to be formulated. The securely attached child is able to tolerate the separation with moderate degrees of protest and distress, return to play and welcome the mother on her return. The...

Countertransference issues

In its broadest sense countertransference refers to all the feelings arising in the counsellor as a result of working with a particular individual. Our humanity and compassion allow us to be emotionally connected with others and to share their joys and pains. The positive side of being affected is that it enables us to help our humanity enables us to reach out to one another and emotionally share by our empathic and compassionate responsiveness. However, in the world of medical genetics there is a negative side to being affected. Counsellors are exposed to the experiences of their patients who may be shocked, overwhelmed with anxiety or fear, grieving or struggling with relationship difficulties and many other emotional challenges. The genetic counsellor is therefore exposed to an emotionally highly-charged environment which can be personally upsetting, challenging or even draining and stressful.

Interpersonal Psychotherapy Rationale

The major goals of IPT, namely to reduce depressive symptoms and improve interpersonal and social functioning, are achieved through the resolution of the primary interpersonal problem area. In IPT interpersonal problems are conceptualized under four principal headings interpersonal role dispute, interpersonal role transition, unresolved grief and interpersonal deficits or sensitivity. At first this may appear to limit the application of this interpersonal model but in practice the challenge is more often to decide with clients which of the competing options generated by this framework will best contribute to their recovery and improved function. By proposing that a single focus be selected IPT does not assume that depressed individuals only experience one difficulty at a time. Rather it provides a framework whereby difficulties may be prioritized for attention based on their relevance to the current depressive symptoms and potential to respond to efforts to achieve change over the...

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion

Influence of disease on sexual pathways and function, but equally important is the impact of the experience of illness. Disease may change body presentation and body esteem ideal sexual scenarios may be disturbed by constraints that accompany illness. In many patients, sexual arousal and desire may decrease in connection with grief about the loss of normal health and uncertainty about illness outcome (51). Damage to the autonomic pelvic nerves, which are not always easily identified in surgery to the rectum, uterus, or vagina, is associated with sexual dysfunction in women (52,53). Medications such as antihypertensives, selective serotonine reuptake inhibitors, and benzodiazepines, as well as chemotherapy, most likely due to chemotherapy-induced ovarian failure, impair sexual response (50). In addition, the incidence of women complaining of lack of sexual arousal increases in the years around the natural menopausal transition. According to Park et al. (54), postmenopausal women with...

Reproductive biology

As with porcupines, people are curious how crocodilians manage to mate without causing each other grief In reality, it is a gentle affair (once the competition has been dispensed with, that is). To copulate successfully, males must court females to gain their consent. Males of some species, such as es-tuarine crocodiles, establish territories that contain a number of females, others, such as American alligators, display competitively to attract females. Courtship may be elaborate or subtle, involving mutual signaling on a visual, olfactory, auditory, and tactile level. Alligators combine rumbling bellows with infrasonic vibrations, the water dancing across their backs proving a potent aphrodisiac for females. Gular musk glands are rubbed across the head and neck in mutual appeasement, and several minutes of head- and tail-raising postures are necessary for consent. Once she consents, the female allows the male to press her underwater. To align his vent with hers, the male rolls the...

Culturally Approved Illness Manifestation

Once we know to what extent individuals adhere to the Latino culture or the U.S. culture, it is important to understand how to culturally tailor further diagnosis and treatment. It would be inappropriate to use Latino culture-specific methods of diagnosis or treatment if the individual is highly assimilated, just as it would be inappropriate to ignore culture-specific methods if the individual is less acculutrated. Culture has been purported to have influences on the perception and definition of mental illness (Kleinman & Good, 1985) and the manifestation and expression of the symptoms (Draguns, 1973 Kleinman, 1988). Some researchers have identified culture-specific disorders in Latino cultures, and have demonstrated the inseparable connection between the mental and physical well-being in the Latino culture (see Molina & Aguirre-Molina, 1994). Some Latinos practice folk medicine and self-medicate through herbs and home remedies. Some examples of folk illness are mal de ojo (evil eye),...

Summary And Conclusions

The interpersonal reconstructive therapy (IRT Benjamin, 2003) case formulation method requires that problem patterns be linked to learning with important early loved ones via one or more of three copy processes (1) Be like him or her, (2) act as if he or she is still there and in control, and (3) treat yourself as he or she treated you. The processes are respectively named identification, recapitulation, and in-trojection. The copying is maintained by fantasies that important persons' internalized representation (IPIR) ultimately will provide the desired love if the patient's living testimony to the IPIR's rules and values is good enough. Such consistent implementation of perceived parental values suggests a continuing wish to please that parent or other important caregiver. Because the relationship with the internalization sustains the problem patterns, treatment must focus sharply on grieving and letting go of these fantasy residuals of early attachments. In IRT, there are...

Nonpsychotic Disorders

The highest frequency of occurrence among nonpsychotic mental disorders is found in substance abuse and alcoholism, which affect over 16 of the general U.S. population (Regier & Burke, 1989). Although alcoholism is at its peak in middle age, many older adults turn to alcohol as a means of coping with grief, loneliness, and pain. Alcoholism in early and middle adulthood occurs more often in men than in women, but, because of loneliness and depression, many women also start drinking in later life (LaRue et al., 1985). Older alcoholics are more likely to manifest impairments in memory and thinking.

Impact of Demographic Socioeconomic and Health Characteristics

As an example of how clients with different tribal or group affiliations can vary, several American Indian tribes, including the Navajo, have strong taboos against speaking of individuals who are dead or the manner in which death occurred. In contrast, the Oglala Sioux, although reticent to talk about death, do not have the same strong prohibitions. A clinician working with an Oglala Sioux tribal member whose relative has been murdered might be able to do in-depth grief work of a cathartic manner once sufficient trust has developed. However, a clinician working with a Navajo tribal member who has suffered loss would be wise to refrain from talking about the specifics of the murder regardless of the level of trust.

General Multicultural Issues

In the study by Paniagua et al. (1998), 55.1 of participants agreed that a discussion regarding the role of the church should be a recommended topic in HIV AIDS educational programs but only 34.2 of respondents endorsed this topic in the strongly recommended scale. (The top four selected topics, i.e., 84 and above, included psychosocial issues 84.1 grief, loss, and death 84.2 ethical issues 82.6 and psychosocial crisis associated with learning that one is HIV-positive 92.8 .) The results in the Paniagua et al.

Stillbirth and perinatal death

Mothers of babies who were stillborn, or died soon after birth, almost always develop grief reactions as found after other forms of bereavement. They are at high risk of prolonged depression and have an increased suicide rate. Fathers are also affected but have not been so thoroughly studied. Management after neonatal bereavement should include opportunities for the parents to see and touch the dead child, encouragement to give the baby a name, take a photograph, hold a funeral, receive an explanation for the death and obstetric genetic advice about future pregnancies, and bereavement counselling from an experienced professional. Such measures have been shown to reduce the duration of psychiatric morbidity.

Significance to humans

The great apes are our closest living evolutionary relatives. The degree of genetic relatedness between humans, chimpanzees, and bonobos is greater than the relationship between gorillas, chimpanzees, and bonobos. Great apes make and use tools, form life-long social bonds, demonstrate grief, spontaneously adopt and care for infants, and show evidence of compassion for each other. They also wage war, rape, practice infanticide, and hunt baboons for food. In captivity, they have learned to use language and numbers, generously accepted humans as social equals, and taught us that the mental differences between humans and the other great apes are only in degree, not in kind. They provide us with the best measure of what is uniquely human, and what we must admit we share with them.

Understanding individual difference in genetic counselling using attachment theory

The last chapter clarified how individuals differ in their management of anxiety and grief and linked it to the perception of genetic counselling and whether it was seen as stressful or not. In addition, individuals were shown to differ in their coping responses and to fall broadly into one of three groups mature, defensive and symptomatic. This is particularly relevant to the counsellor as it explains different approaches and responses to genetic counselling. There are however individual differences in a number of other areas which have relevance for genetic counselling. These differences relate to the way a genetic family story is told, the thinking behind decision-making and the nature and pattern of relationship with the counsellor. All these differences of individual behaviour can be understood by referring to the concepts contained in attachment theory. The theory provides a framework which explains how these differences have arisen and how they are played out in genetics. Armed...

The angry attack on the counsellor

Patient by making a mistake, but with appropriate apologies the damage can be repaired. However, sometimes the anger is inappropriate, disproportional or is the prevailing mood of the patient. When the anger is directed at the counsellor it can be very unpleasant, shocking and potentially destabilising. The counsellor may then take a defensive position and that invariably leads to further anger and the sequence is repeated. The angry attack may mean many different things, some of which include uncontained emotions of an insecurely attached individual, a defence against pain, part of a grieving process or the result of personality difficulties. If at any point the anger becomes excessive or potentially dangerous then obviously the consultation will need to be closed, but fortunately that rarely happens.

Feelings belonging to the counsellor

Genetic counselling contains all the experiences of living which includes births, deaths, illness and pain in individuals (adults and children). The drama of life's experiences is brought into consultations reminding counsellors of their own similar life stories, the universality of vulnerability, personal good fortune or tragedies. Kessler (1992b) remarked that 'over and again professionals are exposed to material which tends to re-open their own past and current wounds'. This is a challenge inviting the counsellor to privately investigate their own emotional processing of both past and present experiences of shock, grief, anxiety and painful family memories. The emotional pain may be recent and the wound particularly raw which can result in the counsellor acknowledging that it is not appropriate to be working in areas where they are being confronted with reminders of recent, incompletely processed pain. The triggering of old experiences can be an opportunity for the counsellor to...

Discussing psychological profile

A psychological profile is built up which furnishes the counsellor with important information about how the individual is likely to cope under the stress of genetic knowledge. It addresses resilience, coping style and whether these will successfully sustain and provide the support needed. The discussion will possibly include previous experience of stressful events and their management by the individual. In addition, it is useful to know the family's reaction to its genetic potential or history, and whether the individual has found that helpful or not. In the Huntington's disease protocol, the counsellor may suggest to the individual that they imagine taking different decisions or having different test results. This exercise helps the individual mentally rehearse the different scenarios and explore and consider their possible future reactions. In this way the counsellor is helping the individual prepare to confront any future anxiety or grief. Soldan et al. (2000) refer to this...

Geriatric Depressed Patients

Interpersonal therapy was initially used as an addition to a pharmacotherapy trial of geriatric patients with major depression to enhance compliance and to provide some treatment for the placebo control group (Rothblum et al., 1982 Sholomskas et al., 1983). Investigators noted that grief and role transition specific to life changes were the prime interpersonal treatment foci. These researchers suggested modifying IPT to include more flexible duration of sessions, more use of practical advice and support (for example, arranging transportation, calling physicians) and recognizing that major role changes (such as divorce at age 75) may be impractical and detrimental. The six-week trial compared standard IPT to nortriptyline in 30 geriatric depressed patients. Results showed some advantages for IPT, largely due to higher attrition from side effects in the medication group (Sloane, Stapes & Schneider, 1985).

Assessment And Intervention

There have been many attempts to categorise grief but little consensus beyond a general view that for most people there is a reduction and change in the nature of distress over time. What is an appropriate time interval or the nature of the distress is less easy to determine. Many studies have used general assessment measures such as the Beck Depression Inventory or the General Health Questionnaire, which were not designed to measure the changes specific to the distress of bereavement. Efforts continue to distinguish 'typical' from 'atypical' grief. The Texas Revised Inventory of Grief (Faschingbauer, 1981) is the best known but it has been criticised for a lack of sensitivity to variation in some items and retrospective judgements. For a comparison for the strengths and limitations of instruments used in the assessment of grief see Neimeyer & Hogan (2001). An assessment scale that attempts to categorise grief will reflect the model of grief and mourning practices that are dominant in...

Reactions During the Counseling Session

Within a counseling session, patients may exhibit a range of emotions, including anger, grief, guilt, and fear. Collecting information about the pattern of cancer in the family can evoke memories of relatives who have died and uncover family dysfunction. Discussing cancer risks and genetic testing options may be frightening prospects and can trigger a number of coping strategies from denial to over-intellectualization. Genetic counselors are well versed in counseling techniques that allow them to be empathetic and actively supportive throughout the session. Since emotional distress can detrimentally influence the capacity to learn, counselors will continually assess the patient's emotional state during the encounter and determine how best to proceed (52).

Post Test Counselingreactions To The Results Reactions to a Positive Result

For women who do not have cancer, a positive BRCA1 or BRCA2 test result typically engenders more emotional distress than a negative test result however, the distress tends to be of short duration. Several studies have shown that mean anxiety and distress scores are not dramatically increased post disclosure (55). In fact, one study showed that the individuals with the highest anxiety levels were the ones who decided not to learn their results (56). These findings provide reassurance that learning one's BRCA1 or BRCA2 gene status does not cause overwhelming anxiety or depression. However, receiving a positive result can bring about feelings of sadness, exacerbate feelings of vulnerability, and retrigger grief responses. For these reasons, many programs have developed resources that target emotional as well as medical needs, such as the formation of support groups targeted to unaffected high-risk women (28).

Describing and naming the process Example

The counsellor responded by empathising with her on how upsetting it must have been to have such distressing news and went on to name her difficulty by commenting, You've obviously been shocked, frightened and been through a sort of grieving process. Your world was turned upside down and you lost how you thought things were. You didn't really know what to do initially and didn't know how to manage and in a grief state went to bed. Now, you are attempting to get yourself together again, you have worked through the shock and are adjusting. What's more you are addressing the problem and wanting to find out about yourself and whether you have the gene'. and grief. That demonstrated the counsellor had understood the upset, and the reason for it. Mirroring and making appropriate statements of understanding the upset can be helpful. However, to understand and explain that she had been struggling to cope with shock and grief and that she has been making an attempt to recover, provided a...

Stressful Life Events In The Light Of Individual Differences Gender Culture Ethnicity And

Multifaceted due to different cultural traditions, religious beliefs, and attitudes toward family. For example, one might assume that in large multigenerational families with close ties between individuals, family members are better able to support each other in the grief process, compared to small families where the deceased may have been the only con dant for those who are left behind. Another example of cultural differences in response to stressful events is the diversity of attitudes toward loss and grief. Often, those attitudes are closely related to religious beliefs within each culture. Gillard and Paton (1999) examined the role of religious differences for distress following a hurricane in the Fiji Islands. They compared the impact of hurricane Nigel in 1997 on Christian Fijians, Indians following Islam, and Indians practicing Hinduism. Results indicated that religious denomination had a differential impact on vulnerability. Gillard and Paton show that one major difference...

The attachment dynamic and systemic thinking

Securely attached families are able to be flexible, supporting one another through challenging situations with individuals moving closer together at times of stress, but not impinging too much on each other. Most importantly, in securely attached families emotions can be processed so that grief can be managed and anxiety contained. With insecure attachment patterns, the situation is different. At the dismissive end of the spectrum the needs of individuals are not met and the importance of the emotional significance is minimised whereas at the preoccupied end of the attachment spectrum, people are trapped in over-involvement, impingement and heightened emotions which are not contained or processed.

A fathers attempt to protect his child from experiencing a disappointment similar to his own

The counsellor had a considerable task of laying the debate in front of the family and working within the context of the particular experiences and individual life story. The most obvious intervention for the genetic counsellor was educative, presenting the ethical dilemma of balancing the child's right to privacy against the parents' right to know and, to observe the effect of that educative intervention. The theme which repeatedly emerged in the consultation was the man's personal disappointment of his dream being frustrated and his desire to protect his child from a similar grief. This led the counsellor to concentrate on a more psychological approach and to make an empathic statement such as 'You are telling me something about your own emotional pain and your desire to protect your child from a similar experience'. The man continued to talk about his disappointment and the effect it had on his life. He thought he had got over it but his upset had been resurrected by his child's...

Regulation of emotions

Approach and response to genetic counselling are related to individual attachment patterns and the ease or difficulty in managing anxiety and grief. With a secure attachment pattern, an individual would be able to approach genetic counselling with appropriate anxiety, confront the reality of possibly having a genetic disorder, analyse the situation, request a consultation and contain the anxiety generated. Further, following a result, the anxiety will be contained and grief processed, demonstrating the possession of a flexible repertoire of cognitive or emotional processing skills. The feelings can therefore be felt, recognised, contained or processed and not interfere with appropriate action. This is equivalent to the mature classification of anxiety management referred to in the previous chapter. In contrast, with an insecure pattern a more defensive approach and reaction will be result, ranging from dismissal to extreme distress. Thus the mature, defensive and symptomatic...

Different coping responses

In their analysis of stress and genetic testing for disease risk Baum et al. (1997) explored the relationship between the disease and the individual's coping. They considered that the extent to which genetic testing for disease causes significant distress varies as a function of the following factors the test results, the characteristics of the disease, the uncertainty remaining after testing, the degree of uncertainty reduction, the availability of active coping option and personal factors such as social support, optimism, perceived risk and beliefs about disease and disability. As a consequence, the interaction of all these factors results in a range of coping responses which have been described in varying ways. These include adaptive or maladaptive (McConkie-Rosell and Sullivan, 1999), or resilient, normal stress and pathological stress response (Horowitz et al., 2001). However, in this text the terminology adopted by Tibben (1993) is used - that of mature, defensive and...

The importance of early attachment pattern and the effect of an early disruption being exposed in genetic counselling

This woman's traumatic early experiences of separation from her mother, and the unsatisfactory relationship with her father with his unpredictability, probably afforded her a disorganised attachment pattern. As a child she was left without a supportive adult and was not able to make sense of events or manage her anxiety and grief. In the protocol for Huntington's disease she had not shown any signs a disorganised attachment with the extremes of emotion which were seen after the test result. This suggests that she had an insecure attachment pattern which was mixed. At times it was at the dismissive end of the spectrum and at other times it swung to the preoccupied end or, alternatively, revealed a disorganised pattern with an excess of distress which could not be managed. Her relationship with her husband and the counsellor was one of needing to stay close, clinging and demanding as she struggled with mounting panic. Not only was she unable to process the anxiety and grief at her...

Understanding and naming the process Example

'You seem to have moved a long way in adjusting to the news, you were initially quite shocked and then very distressed. I would guess you were frightened and grieving for the loss of your life as it was. And now you are here to talk about it all and find you can cry1. The woman responded Both daughters were attempting to manage the pain, the one by intellectualisation and the other by displacement activity. The defence of intellectualisation brings people for a consultation, facilitates understanding and planning and gives a sense of control. However, displacement activity is an attempt to get control of what is experienced as uncontrollable feelings. In the woman's description it is possible to hear her shock at the news of her father's illness, and also that she is experiencing another stress as she feels her future marriage may be threatened. As in the last example the counsellor's intervention did not simply mirror her feelings, as it also gave the woman an understanding and...

Depressed HIVPositive Patients IPTHIV

Recognizing that medical illness is the kind of serious life event that might lend itself to IPT treatment, Markowitz etal. (1992) modified IPT for depressed HIV patients (IPT-HIV), emphasizing common issues among this population including concerns about illness and death, grief and role transitions. A pilot open trial found that 21 of the 24 depressed patients responded. In a 16-week controlled study, 101 subjects were randomized to IPT-HIV, CBT, supportive psychotherapy (SP), or IMI plus SP (Markowitz et al., 1998). All treatments were associated with symptom reduction but IPT and IMI-SP produced symptomatic and functional improvement significantly greater than CBT or SP. These results recall those of more severely depressed subjects in the NIMH TDCRP study (Elkin et al., 1989). Many HIV-positive patients responding to treatment reported improvement of neurovegetative physical symptoms that they had mistakenly attributed to HIV infection.

Social Support Rights And Responsibilities

Personal emotional support is the empathic, caring exchanges given and received in relationships characterized by mutuality, liking, and interdependence. Throughout all stages of the life span, personal emotional support contributes to the individual's growth and well-being. Having a caring person to listen and be available for confiding in is important for the enhancement of life satisfaction and morale. The loss or absence of this type of relationship can result in emotional isolation, loneliness, depression, grief, and anxiety (Dugan & Kivett, 1994).

How Cities Affect Lgbt Health

In addition to the risks posed by social networks, urban LGBT people face other stressors. One such stressor is the history of the HIV epidemic in the LGBT community, particularly in urban areas. Many LGBT people witnessed large numbers of friends and lovers suffer and die from AIDS during a time when medical treatments were few and government and social support for people living with AIDS was minimal. These experiences of care-giving and grief, which continue today, add to the overall experiences of stress and distress LGBT people face (Gluhoski, et al., 1997 Morin, et al., 1984 Turner and Catania, 1997). The heightened risk of HIV in urban areas and the constant vigilance that is required to prevent transmission maybe also experienced as stressful by some MSM (McKirnan, et al., 1996).

Feelings belonging to the patient but experienced by the counsellor

When two people are together and one is talking about their life and its pain the most common experience is empathy. This enables the counsellor to understand the patient's subjective experience, which has been conveyed in words, feelings, actions and gestures. The counsellor achieves that understanding by not only listening and feeling, but also imagining what it must be like asking questions to clarify and confirm what the patient is actually feeling. Tarnopolsky (1995) describes empathy as the resonance between patient and therapist, 'the I-know-how-you-feel' response, with a warm feeling of togetherness. In an earlier chapter on the skills of psychotherapy, the importance of including an understanding of intent was emphasised as giving empathy its full therapeutic power. Consider the following two statements in response to a grieving patient. In the first the counsellor reflects to the patient, 'you are very sad and missing your husband'. In the second the counsellor includes a...

Summary points

Genetic counselling has the potential to be psychologically stressful since it involves a change and demands an adjustment. It can trigger anxiety, grief and frustration. Stress is only experienced if the individual perceives the process as a threat, and the individual is then challenged to cope. Stress can interfere with decision-making. Coping involves cognitive and emotionally focused processing working together to enable the individual to cope. Essentially coping involves the management of anxiety and grief. Individuals differ in their management of anxiety and grief and frustration and fall into one of three groups mature, defensive or symptomatic.


Grief following major bereavement has been described as having four classic phases An abnormal grief reaction may be diagnosed if grieving is unduly prolonged, if grief cannot be expressed, or if there is denial that death has occurred. Bereavement may precipitate psychiatric illness, usually depression, or suicide in vulnerable people. Abnormal grief reactions are more common if the deceased was young, if the death was sudden or violent, or if the bereaved person's relationship with the deceased was complicated by guilt or ambivalence. Psychotherapy is often appropriate for abnormal grief reactions for example, the technique of 'guided mourning' to help the patient acknowledge and grieve the death.

Prenatal clinic

The degree of emotional pain and the added intensity in these clinics are linked to the fact that a future child is involved. Symbolically, the foetus is an everyday miracle of life created by individuals, representing their love. Abnormalities in this area can be regarded as an attack on the individual's creativity and an interruption of the sense of immortality carried in the future generations. The fact that a child is involved easily engages a counsellor's compassion and empathy. This is essential for the success of the consultation, but in this area there is possibly a greater risk that the counsellor will be over-involved or identify with the grieving parents. In this highly emotional area the counsellor needs to be able to tolerate the degree of distress without becoming professionally mechanistic, overwhelmed, over-involved or too helpful. Working through the upset with a couple is complicated as each individual has to personally process the emotions and consider the feelings...

Funeral Practices

Bereavement, the loss of a loved one by death, is almost always followed by the mental state of sorrow and distress known as grief. The culturally prescribed pattern of behavior by which the grief caused by bereavement is expressed is referred to as mourning. The duration of mourning and the specific conduct of mourners, such as wearing black and restricting one's social activities, and flying flags at half mast, have varied with the historical period and culture. In today's Western culture, the duration of mourning is typically fairly short, and many older customs associated with it have been abandoned. Numerous practical matters concerned with the funeral, the deceased's estate, and new domestic and other duties of the spouse or other immediate family members must be taken care of. In addition, the survivors must contend with various psychological and social concerns associated with the death. In short, the survivors must find ways to let go of the deceased and get on...

Natural Disasters

Traumatic grief has been shown to be a risk factor for mental and physical morbidity (Miller & Wortman, in press). When widowers feel socially isolated during the grieving process, they may develop depression and loneliness, which in turn may lead to more severe consequences. In other cases, their immune system or cardiovascular reactivity may be affected, resulting in illness and eventually in death. The mechanism of pathogenesis needs to be further explored. Not only is death from all causes higher among widowers, but also speci c causes of death, such as suicide. Li (1995), for example, showed a ve times higher risk of suicide for elderly widowers than for married men. In contrast, the relative risk to commit suicide among the widows was near zero.

Support groups

Bereavement and grief counseling groups provide support to people who have experienced a loss. There are groups for people who have lost a spouse or partner, parents, children, or pets. There are specific groups for people who have lost a loved one due to homicide, suicide, SIDS, cancer, or miscarriage. These groups help individuals adjust to the death of a family member or friend, learn how to accept the loss, honor the memory of their loved one, and adjust to life after the loss. See also Grief counseling and therapy

Genetic Counselling

The role of a genetic counsellor is to mediate between the rapid advances in molecular medicine and an individual's ability to understand and manage the risks of their inheritance. Counsellors therefore, need to be fully in command of the psychological impact of their communications. Written by a psychiatrist who later became a psychotherapist, this book is essential reading for counsellors of all disciplines. It examines the psychological processes involved and uses the framework of attachment theory to explain why people approach and respond to genetic counselling differently. Effective counselling requires a knowledge of the principles from individual and family therapy. In particular an in-depth understanding of empathy enables the counsellor to help the individual contain anxiety and process grief, and so facilitate decision-making or help with the effects of having a test result. The effect of counselling on the counsellor is examined creatively in order to enrich the interview...


Having a genetic disorder may seriously interfere and frustrate long-standing plans, ideas, ambitions or even ordinary living when the condition is debilitating. The individual may have to review future plans of job prospects, possible marriage or having children. It may also prevent an individual being able to have personal insurance. Varying degrees of adjustment will be necessary for the individual to live a life which includes the consequences of the genetic disorder. From the point of view of psychological management, the principal task is the resolution of anxiety and grief. For simplicity in further discussions about stress and emotions, frustration will be seen as a corollary.


It has been emphasised how anxiety interferes with decision-making and how the task of the patient is to contain extremes of emotion to aid decisionmaking and to process the effects of a result. The counsellor becomes involved in helping with this process, especially when the patient has an insecure attachment pattern and is unable to successfully manage the emotions. The containment of anxiety is a core element of a genetic consultation. It relates to the ability to think in a way which involves the linkage of ideas and the ability to deduce meaning such that one way of measuring the success of the counselling encounter would be to reach a point when the individual can think clearly. In Bion's model, the precursor of this capacity is related to the mother's capacity to contain and process the infant's chaotic experiences and to make sense of them. The mother understands the infant's distress by conveying an understanding of the emotion and the intent or desire. In conveying this, her...

Phases of Treatment

The therapist assesses the need for medication, based on symptom severity, past illness history, treatment response, and patient preference, then provides psychoeducation by discussing the constellation of symptoms that define major depression, their psychosocial concomitants and what the patient may expect from treatment. The therapist next links the depressive syndrome to the patient's interpersonal situation in a formulation (Markowitz & Swartz, 1997) centred on one of four interpersonal problem areas (1) grief (2) interpersonal role disputes (3) role transitions or (4) interpersonal deficits. With the patient's explicit acceptance of this formulation as a focus for further treatment, therapy enters the middle phase. In the middle phase, the IPT therapist follows strategies specific to the chosen interpersonal problem area. For grief - complicated bereavement following the death of a loved one - the therapist encourages the catharsis of mourning and, as that affect is released,...


Patients with malignant gliomas often develop progressive neurobehavioral deficits caused by the disease itself as well as treatments such as radiation and chemotherapy (19). Depression in brain tumor patients can be related to the stress of the diagnosis, treatment, loss of function, or medications. Almost all patients faced with a potentially terminal diagnosis will experience, at minimum, temporary grief and anxiety. Patients may benefit from counseling, psychotherapy, or medication. Some patients may resist but studies have shown that patients have an improvement in overall QOL when emotional distress is treated. One recent study showed that patients wanted and expected more support than they were receiving, especially psychological support. They wanted someone to talk to them and spend more time with them (21). A combination of drugs is often necessary and should not be withheld but neither should they replace compassionate care (22). Stress reduction is essential. Cautious use...

Examples of denial

Death is a common occasion for denial. When someone learns of the sudden, unexpected death of a loved one, at first he or she may not be able to accept the reality of this loss. The initial denial protects that person from the emotional shock and intense grief that often accompanies news of death. Chronic or terminal illnesses also encourage denial. People with such illnesses may think, It's not so bad I'll get over it, and refuse to make any lifestyle changes. See also Grief Psychoanalysis Psychodynamic psy- o

Giving bad news

No one wants to be the bringer of 'bad news' we prefer to be pleasing people and that makes us happy and leaves a good feeling all around. In contrast, the bearer of 'bad news' is the messenger who carries the information which can change an individual's life and that can impact on the counsellor in a number of ways. The counsellor is the first to have the information. Naturally, the counsellor reflects on how it might impact on the individual and, in that process, the counsellor triggers a personal preparatory grieving, before giving the news to the patient (Quill and Townsend, 1991). In predictive testing the topic is often included in a genetic counselling interview with advance agreement about how the individual wants to be told, whether face

The Hospice Movement

As a third principle, hospice care includes support for the survivors throughout their bereavement. Proponents of hospice principles recognize that many family members need ongoing support both during their care for terminally ill relatives, including respite care and experiences of anticipatory grief, and after the death of the patient. Finally, as a significant principle in hospice care, dying persons are treated as ends in themselves and not as means to something else. Dying persons, if cognitively alert, have purposes and goals of their own, and these should be recognized and facilitated. Further, dying persons should have their autonomy and abilities to be self-determining maintained and enhanced for as long as possible. Hospice care attempts to understand illness and dying from the perspectives of patients, including listening to and learning from patients and giving primacy to biographical stories of patients over clinical stages of dying. Stories refer to the narratives of...

Related issues

One group of people that is often overlooked in discussions of suicide is the friends and family bereaved by the suicide. It is estimated that each person who kills him- or herself leaves six survivors to deal with the aftermath. On the basis of this figure, there are at least 4.5 million survivors of suicide in the United States. In addition to the grief that ordinarily accompanies death, survivors of suicide often struggle with feelings of guilt and shame as well. In spite of a general liberalization of social attitudes since World War II, suicide is still stigmatized in many parts of Europe and the United States. Survivors often benefit from group or individual psychotherapy in order to work through such issues as wondering whether they could have prevented the suicide or


It is apparent that there is no strong evidence base as yet to decide which interventions would be most beneficial to individuals who request help. The factors that have been assumed to increase risk of complicated grief are also questioned by Stroebe & Schut (2001) who argue that these factors are subject to mediating variables such as social support and are complicated further because some risk factors are not static, for example, self-care. It is beyond the scope of this chapter to examine all aspects of bereavement therefore specific areas of bereavement have been selected to illustrate the changing practice and debates.

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