Loss and Grief the Loss

¶ … Loss and Grief The loss of a loved one is a traumatic event which can take months or even years to overcome fully (Tomita & Kitamura, 2002). Bereavement though, is if anything more acutely experienced in children and adolescents who are not equipped with the psychological and social tools necessary to understand loss and move effectively on with their lives. Bereavement counselors are crucial in the development of healthy mechanisms for coping with loss (Burnett et al. 1997).

Strategies such as art therapy, client centered therapy, self-assessment measures, and interviews are utilized to aid these social care workers in their immediate understanding of subjective individual grief and how best to address their client's needs. Continuing research into which strategies are most effective and efficient is vital to the successful treatment of children experiencing loss. Introduction A 1999 U.S. census reported that more than two percent of children under the age of 18 had experienced the loss of at least one parent (U.S. Social Security Administration, 1999).

It is further estimated that as many as five percent of children in the United States will experience the loss of a loved one before their fifteenth birthday (Currier, Holland, & Neimeyer, 2007). The time lapse between the collection of those two pieces of statistical data indicate that if anything the trauma of crucial loss for minors is on the rise in the United States. This trend alone is impetus enough to redouble efforts to effectively treat those individuals suffering the trauma of loss.

It is essential that the personnel in positions of counsel and support are trained in the most effective, efficient, and recent methods of helping bereaved children. The experience of crucial loss during an individual's lifetime is a statistical probability. It is only rarely that individuals manage to experience their entire lifetime without losing a close friend, family member, or loved one.

Unfortunately it is also a statistical probability that in the current global political climate, and state of environmental change, individuals will experience the massive loss of life resulting from natural disaster or war as well. The tools and skills developed by social aid workers and researchers which prove effective and efficient in the smaller scale of individual family interventions will ultimately help to ease the inevitable trauma of such global experiences as the January earthquake which left thousands of Haitians displaced or worse dead.

While it is essential that children experiencing loss and consequently grief should be guided through the process of losing a loved one, there is a degree of controversy regarding the actual benefit of bereavement counseling. In a study conducted by Neimeyer in 2000, 38% of individuals who received treatment were likely to have been better in the long-term having not been counseled at all (Larson & Hoyt, 2007).

While the Neimeyer study was ultimately overturned as his conclusion was drawn from an unpublished and untested study, such pessimism in the field of bereavement counseling is valid. In light of true meta- analytic studies which adjusted for pre and post test data inclusion, it was observed that many existing treatment strategies were so weakly effective that they were of little tangible relief (Larson & Hoyt, 2007).

Especially in the aftermath of a traumatic event irrespective of the scale of that event it is the duty of social aid workers and professional counselors to alleviate stress, not add to it by involving grieving individuals in therapy which is ultimately of no help to them. Abnormalities in the grieving process are positively correlated to increased vulnerability for psychological disturbances or disorders later in life (Currier et al., 2007).

Even with evidentially supported successful techniques, that is strategies which aid a significant group of participants to adjust normally, as many as fifteen percent of those children receiving bereavement counseling will still experience psychological, social, and behavioral problems two years after the loss (Currier et al., 2007). These problems have the potential to become lifelong disadvantages if appropriate measures are not taken immediately to effectively return the child to a normative state of behavior and psychological functioning.

The significance of continued research into, and adaptation of bereavement counseling strategies for juveniles, defined as those individuals who experience crucial loss before age eighteen, is multimodal. If a child who experiences a crucial loss is successfully guided through the grieving process, it is likely that they will return to a normative level of psychosocial functioning within months of the loss thereby allowing them to move forward in their life meeting developmental goals without additional disruption caused by the loss event (Gwynne, Blick, & Duffy, 2009).

These children are unlikely to require further counseling as a result of this loss event in future making available those resources for other individuals in need of assistance. Successful grief counseling may also reduce the likelihood that the individual engages in self-harm or suicidal actions and ideations later in life preventing the experience of crucial loss for their family members as well as saving their life (Stroede, Schut, & Stroede, 2007).

Finally the data collected as a result of this continued research and application in the field in relatively smaller context of individual families will be applicable to large scale events, maximizing the efficacy of social aid workers in times of crisis. Literature Review Existing data supports the increasingly popular hypothesis that current methods of bereavement counseling are statistically ineffective (Larson, & Hoyt, 2007). Further, that the outcome of psychotherapeutic techniques is more effective than those specifically designed for grief counseling (Larson, & Hoyt, 2007).

While it may be feasible to employ psychotherapeutic techniques in individual familial settings it would be impossible to employ those techniques on a larger scale in terms of a crisis. Though the ultimate goal of counseling is helping an individual return to normative psychosocial function allowing them to participate more fully in their life and work, it is important to bear in mind the need for effective, efficient, and reliable treatment protocols which can be standardized and used across a variety of scenarios.

One important area of bereavement counseling research is the standardization for criteria of inclusion in a bereavement counseling program. While it is true that all children should have guidance as well as a safe space to air their feelings in terms of their subjective experience of loss, it is not true that all children who experience loss require counseling. The inclusion of study results of children who displayed no clinically relevant symptoms prior to counseling will present a significant confound for the collection of useful data.

Necessarily if prior to the treatment they experienced no negative psychological symptoms, after they should exhibit no significant change. There is also the possibility though that the experience of counseling will result in negative behavioral and psychological outcomes as a result of having to relive and reiterate a traumatic experience such as the loss of a loved one (Forte, et al. 2004). Types of bereavement interventions can be divided into three categories; primary, secondary and tertiary interventions (Stroebe, Stroebe, & Schut, 2007).

Primary interventions are those interventions such as immediate one on one grief counseling which are made available to all individuals who experienced loss irrespective of their specific need for intervention. Simply following the death of a loved one in a hospital setting for example, the grief counselor for the institution will approach the family making their availability known and offering some helpful suggestions to begin the healing process.

These interventions are the least invasive in that they are available if necessary yet no one is compelled per se to attend (Forte, et al. 2004). Secondary interventions are more intensive and targeted specifically at those individuals who present non-normative responses to their grief. Offered in the immediate aftermath of a loss, individuals are generally referred to this type of loss counseling through their primary intervention provider or as a result of their apparent need for further assistance.

In the case of children and adolescents it is unlikely that they would seek this aid on their own, however, it would likely be acquired through parent or guardian intervention (Forte, et al. 2004). Tertiary intervention is the intervention which occurs more than three to six months after the loss event. This is primarily focused intensive therapy intended to treat the presentation of post traumatic stress or depression as a result of bereavement (Forte, et al. 2004).

While the other two types of bereavement intervention are relatively short-term, primary generally only continuing for one to five sessions and secondary intervention lasting perhaps two months, tertiary interventions can potentially last for years depending on the severity of the symptoms. Particularly with children the long-term effects of grief if not properly assessed and treated may result in the presentation of or vulnerability to a number of negative mental health outcomes (Forte, et al. 2004). Techniques commonly employed in primary interventions include art therapy, interviews, and psychodynamic counseling.

These techniques enable counselors to assess the individual's current mental state as well as dynamically alter the course of treatment in accordance with the manner in which their patient responds. Art therapy is particularly useful with younger children. With children under the age of eight it can be difficult for them to grasp the concept of death, it can be equally as difficult for them to express the things they are feeling about the loss of a loved one (Shaw, 2000).

Through the medium of drawing or painting a counselor may gain a better understanding of their patient's subjective experience of the loss as well as any unresolved emotions or unanswered questions remaining after the fact. Art therapy is also an effective means of determining the relative normality of a child's cognitive function following a traumatic event (Shaw, 2000). Older children respond more effectively to client centered interviews (Shaw, 2000).

A client centered interview is a psychoanalytic approach which encourages the patient to talk extensively guided minimally by questions or suggestions from the therapist. This approach might allow through the extensive vocalization of formally internalized feelings, thoughts, and questions the root of any unresolved issues associated with the loss which may have proven detrimental to the client's successful continued psychological functioning (Shaw, 2000).

Secondary intervention techniques are more intensive as the behavioral and psychological problems associated with bereavement are apparently persisting to a degree which is disruptive to the individual's daily functioning (Gwynne, Blick, & Duffy, 2009). These techniques include weekend retreats and even the referral to group therapy session or support groups. While it is at times useful to spend a significant period of time reliving a significant life event such as the loss of a loved one, in children it may ultimately prove more harmful than helpful (Larson, & Hoyt, 2007).

Perpetually reliving a traumatic event may actually reverse the process of healing and acceptance especially with younger adolescents effectively trapping them in that stressful and difficult time. The participation in group therapies and support groups allows individuals particularly adolescents to gain a sense of camaraderie which can be important in times of grief, however, these groups may act to foster malingering or even a psychological dependence on the sympathy and attention garnered at such sessions (Larson, & Hoyt, 2007).

Tertiary intervention techniques are long-term therapeutic treatment plans including behavior modification, drug regimens, and standing appointments with therapists for the treatment of pronounced disorders resulting from bereavement. It is the function of primary and secondary intervention strategies to prevent the majority of individuals in need of some bereavement intervention from reaching this final and most severe treatment stage (Burnett et al. 1997).

To qualify for a tertiary intervention treatment an individual must display a pervasive and fundamentally disruptive pattern of behaviors stemming from the loss event and preventing their successful reintegration with society (Tomita, & Kitamura, 2002). In the case of children, the need for a tertiary intervention is especially concerning in that it will inevitably impact the rest of their lives.

Given the generally pessimistic review of bereavement intervention techniques shared by the majority of researchers, it would be interesting and probative to determine whether the results of these trials are replicable in the field. Rather than including all data, it would be of use to screen participants prior to the inclusion of their treatment objectives and outcomes in the raw data collected.

If treatment is provided efficiently and immediately only to those individuals actually in need of counseling, it is my contention that intervention techniques would produce statistically significant results in lessening the amount of time necessary for participants to return to normal functioning following a crucial loss. Method Design This study will be cross sectional. A local hospital will be chosen based on proximity to the researcher as well as their willingness to participate in the study. The grief counseling department will agree to turn over redacted records of applicable participants.

No personally identifying information will be included about the participants themselves, nor will the researcher have any interaction with them. The grief counseling center will provide the participants with a copy of the Inventory of Complicated Grief before and after the therapy as well as the Core Bereavement Items measure. The inventories as well as general nature of the therapeutic intervention including; who initiated the therapy, duration of therapy, and clinicians opinion of efficacy of therapy will be turned into the researcher upon conclusion of the study period.

All participants will receive a briefing form prior to their completion of the inventory. Participation will be entirely voluntary and informed consent will be required for their inclusion. Sample Ideally the sample would include an ethnically, economically, and age diverse group of participants. However, as this study utilizes convenience sampling such normative distribution is unlikely to occur naturally. As such a number of local hospitals should be included in the study. Further, only participants who score greater that 25 on the ICG and greater than 17 on the CBI.

This ensures that only individuals presenting with a genuine need for therapeutic intervention will be included in the data analysis. It is important to limit the sample to those individuals genuinely in need in order to ensure that the effects observed are actually a result of therapeutic intervention. Measures The two measures proposed for the study are the Core Bereavement Inventory (CBI) as well as the Inventory of Complicated Grief (ICG). The CBI is a 35 item self-assessment scale which measures the subjective experience of loss.

Composed of three internal subscales which assess thoughts, separation, and grief this scale is easy to administer yet highly informative in terms of assessing a full picture of the individual's relative psychological functioning. The scale has a cronbach's alpha of .85 which is a reasonable level of internal reliability. Further, this scale is attractive because it can be used with children and adolescents. The ICG is a 19 item scale which assesses the physical components of grief and the degree to which they are disrupting an individual's life.

This scale specifically measures symptoms of grief distinct from unrelated depression or anxiety. A cluster.