¶ … Efficacious Interventions for Grieving Families In response to the recent mass shootings in Orlando, Florida that claimed the lives of 50 innocent Americans, Orlando's public and private sectors have come together to offer grief counseling services to family members and friends affected by the tragedy as well as any other citizens who were traumatized by these events. This generous offer underscores the need for timely and efficacious grief service interventions for families that have experienced traumatic events including the violence loss of loved ones. Because this population is enormously diverse and there are no "one-size-fits-all" interventions that are equally effective in all settings, however, it will be important to provide culturally sensitive and individualized interventions that are most appropriate for a given family. To help illustrate these issues, this paper reviews the relevant literature to develop a case study of a hypothetical family that has experienced a recent traumatic event that requires grief services, including a relevant family history and important cultural considerations that should be taken into account. An evaluation concerning the optimal approach to developing advocacy services for this family is followed by a proposal discussing the interventions that should be used, including the rationale in support of these interventions and the methodology that should be employed following best evidence-based practices. Finally, an explanation concerning relevant legal and ethical considerations and how the program conforms to these considerations is followed by a summary of the research and important findings concerning the provision of efficacious and timely grief service interventions which are provided in the conclusion.

General Description of the Population of Interest

Both surviving adults and children can suffer from a wide range of emotional and physical disorders following a traumatic event or major loss in their lives, but young people are especially at risk of experiencing these outcomes (Walker & Shaffer, 2007). For instance, Walker and Shaffer (2007) report that, "The experience of grief wears many faces for children and adolescents. The [violent] death of a loved one, sexual abuse, physical abuse, abandonment, pregnancy loss, or an incarcerated parent often leaves a teen struggling to cope with life" (p. 67). Although everyone experiences grief in unique ways, some of the adverse outcomes affecting this population include self-destructive behaviors (including suicide and self-mutilation), substance abuse, depression, and eating disorders (Walker & Shaffer, 2007). Taken together, it is clear that this population requires timely and efficacious grief services in order to help them better cope and respond to these traumatic events in their lives. To gain a better understanding of how these needs apply to a representative family, the history of a hypothetical family that experienced these types of losses is provided below.

Family History

The Hans Muller family immigrated to the Chicago suburb of Palatine from Germany in 2010. The Muller family recently experienced the loss of their unborn daughter during Mrs. Muller's seventh month of pregnancy due to a miscarriage resulting from a fall on the ice in front of the family home. The Muller family is now comprised of Mr. Hans Muller, aged 35 years, Mrs. Eve Muller, aged 33 years and their twin son, Albert and Ben, aged 14 years. Both parents are employed time (Mr. Muller as a full-time electrical engineer and Mrs. Muller as a part-time piano teacher) and both sons attend the same local public high school where they report doing well academically prior to the loss; however, both sons report having trouble concentrating in class and concede that their schoolwork has suffered. The Muller family also has an extended family still living in Germany, including Mr. Muller mother, both of Mrs. Muller's parents as well as numerous aunts, uncles and cousins. All of the Muller family members are highly fluent in English and all immediate family members were adversely affected by the loss in different ways and degrees.

Cultural Considerations that Must be Taken into Account

Although the Muller family has lived in the United States for 6 years and has become fully assimilated into American culture, many people of German origin have a cultural tendency to feel the need to remain stoic in the face of grief-invoking events (Ibsen, 2012). Some authorities attribute this tendency, at least in part, to the profound collective national guilt and grief the German people have experienced since the end of World War II (Moore, 2005). In this regard, Moore (2005) reports that, "Hitler had tried to erase a people; he would have gone on to erase London and Moscow and New York. And yet the towering moral shame still shadowing German pride is not enough to erase a collective, unspeakable grief" (p. 22). While not every German family may experience these feelings on the same level,...

Indeed, the National Childhood Grief Institute reports that more than 30,000 American families loss a child each year (Hoffman, 1996). Developing appropriate advocacy services for these families, however, requires an individualized approach that not only takes into account any salient cultural differences, but the specific needs of the family members. For instance, Scott (2014) emphasizes that, "Coping skills will vary from client to client and are recommended to target the loss of family and nonfamily members, the internalization of pain and fear, trauma from being displaced from family and friends, and extreme community violence" (p. 175). Based on these considerations, descriptions of the recommended interventions for the Muller family together with rationale in support of these methods are provided below.
Description of Recommended Intervention and Supporting Rationale

The Mullers are faced with some profound challenges in coping with the grief associated with their loss. For instance, according to Murray (2009), "Parents who experience the death of a child of any age are faced with the need to construct new realities and reconstruct old ones, for common culturally held assumptions about themselves or the world no longer match their experiences" (p. 277). Therefore, the adult members of the Muller family should be provided with cognitive-behavior therapy (CBT) to help them cope with their grief. A growing body of evidence confirms that CBT therapy has proven efficacy in helping parents cope with the grief associated with their loss of a child (Hoffman, 2012). Moreover, CBT therapy has been used by clinicians in other countries including Germany with good effect (David, 2007).

By contrast, a study by Rask, Kaunonen and Paunonen-Ilmonen (2002) found that the most effective interventions for that the most effective interventions that helped adolescents aged 14 to 16 years to cope with their grief following the loss of a sibling were (a) self-help programs and (b) support from surviving parents and other friend members, relatives and friends. These types of support programs can help young people better understand the grieving process and recognize that their experience is normal (Rask et al., 2002). In addition, support programs can help young people learn healthy ways to express their grief that can facilitate the recovery process (Rask et al., 2002).

Description of Methodology

Based on the foregoing considerations, a family member-specific intervention using CBT therapy for the parents and self-help programs and a support network for the twin adolescent sons represents a viable treatment strategy. This support network can also include community- and school-based resources (Sussman, 2011). To ensure that all relevant legal and ethical considerations are taken into account and the program is aligned with them, clinicians providing grief counseling services must conform to all relevant professional codes of ethics and conduct in their jurisdiction (Hemingway & Querin, 2011).

Conclusion

The loss of an unborn child can be a devastating experience for all family members, including most especially parents and siblings. The research showed that while the experience will be manifestly unique in everyone, there are some common adverse mental health and physical consequences that are associated with this type of loss that can have long-lasting debilitating effects if left untreated, including suicide, self-harming behaviors, substance abuse and depression. Likewise, because everyone's coping skills and resilience differ, it is also important to draw on individual strengths where possible, making the use of cognitive behavioral therapy especially relevant for parents who experience the loss of a child. Similarly, the use of self-help programs and a support network has proven efficacy in helping adolescents cope with the grief that is commonly associated with the loss of a sibling. Finally, the research also showed that it is important to ensure that the provision of these interventions conforms to all relevant professional codes of conduct and ethics.

References

David, D. (2007, September). Quo vadis CBT? Trans-cultural perspectives on the past, present, and future of cognitive-behavioral therapies: Interviews with the current leadership in cognitive-behavioral therapies. Journal of Evidence-Based Psychotherapies, 7(2), 171-175.

Hemingway, C. W. & Querin, D. S. (2011, March-April). Ethics codes and the law: Code provisions often have relevance well beyond the group establishing the code. Addiction Professional, 9(2), 18-21.

Hofman, S. G. (2012). An introduction to modern CBT: Psychological solutions to…