Understanding Grief: Assessment and Treatment Planning

John C. “TC” Megahan, Sr.President and Sr. Bereavement Counselor

The Journey of Hope, IncBear, Delaware

Carl and Ellie: A Love Story

Defining and Understanding Grief?Grief can be defined as the physical, emotional,

cognitive and spiritual response to actual or threatened loss of a person, thing or place to which individuals are emotionally attached.

"Contrary to what social workers will tell you, when you lose a loved one, we don't just forget, move on, and find closure. To truly grief, we must learn to honor, to remember, and to incorporate our deceased children, parents and siblings into our lives in a new and different way. In fact, keeping memories of your loved one alive in your mind and heart is an important part of your healing journey." ~ John "TC" and Joanne Megahan RESTORING HOPE.

Common Grief ResponsesFeelings

Numbness

Shock

Anger

Anxiety

Loneliness

Fatigue

Yearning

Relief

Common Grief ResponsesPhysical Sensations

Tightness in the chest

Shortness of Breath

Lack of Energy

Panic Attack-like symptoms

Common Grief ResponsesCognitions

Disbelief

Confusion

Sense of Presence

Lack of Concentration

Common Grief ResponsesBehaviors

Sleep disturbances

Appetite disturbances

Social withdrawal

Dreams of the deceased

Absent-minded behavior

Common Grief ResponsesAdditional considerations

Cultural Differences

Religious Differences

Gender Differences

Grief experience and history

Differences between Grief and Depression

It is important to understand and recognize the difference between Grief and Depression.

Depression shares common features with grief. Misdiagnosis can result in overlooking depression when it is present and inappropriately treating grief.

Assessing between Grief and Depression

Grief

Experienced in waves

Diminishes in intensity over time

Healthy self-image

Depression

Moods and feelings are static

Consistent sense of depletion

Sense of worthlessness and disturbed self-image

Assessing between Grief and DepressionGrief

Anhedonia -  Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences.

Hopelessness

Response to support

Overt expression of anger

Depression

Anhedonia -  Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences.

Pervasive hopelessness

Unresponsive to support

Anger not as pronounced

Assessing between Grief and Depression

Grief

Guilt is focused on aspect of loss

Not demoralizing or humiliating

Preoccupation with deceased

Suicidal gestures rare in

uncomplicated grief

Elicits sympathy, concern and

desire to embrace

Depression

Guilt is preoccupied with a

negative

Demoralizing and humiliating

Preoccupation with self

Suicidal gestures are

common

Elicits irritation, frustration

and a desire to avoid

Grief Assessment

What was the relationship?

Nature of the Attachment

Mode of Death

Historical Antecedents (preceding event, condition, causes, etc.)

Personality Variables

Social Variables

Theories on Bereavement

Elizabeth Kubler-Ross: Stages of Grief

William Worden: Four tasks of grieving

Robert Neimeyer: Rebuilding life and search for meaning

Grief as a journey.

Treatment Planning Establish a relationship with the bereaved

Be comfortable with their expression of

grief

Listen, listen, and then listen some more

Normalize grief reactions

Companion them in rebuilding their life

Taking Care of Myself

Know your own strengths and limits

Set boundaries, communicate those boundaries.

Nurture yourself – read, watch, and listen positive and supportive information.

Surround yourself with supportive people.