Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster both the cost and sometimes the supports are greater. Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon.
These are particularly challenging times for children who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community.
Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary.
The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed. This article addresses counseling with complex grief and trauma, not only complex post-traumatic stress disorder but those conditions of traumatic loss and psychological trauma that for a number of reasons are enduring or disabling.
For example, where an adult is periodically immobilized by unwelcome and intrusive recall of the sudden and violent death of a parent in their childhood. One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.
Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the self, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques to best fit the presentation of the problem.
The post-traumatic self may not be the same person as before. The client was afraid to admit these complex feelings to Oliver because he was ashamed for feeling resentment, anger and relief when he thought he should be feeling only grief. Rookey has used exposure therapy to help clients process unresolved trauma around losses that they experienced firsthand.
Rookey used the approach with a woman who became triggered by the sound of sirens after she watched her partner die from a traumatic accident. While the woman was sleeping, her partner went outside to smoke, and he was shot after being caught in the middle of a botched burglary. By the time the woman woke up and realized what was happening, her partner had crawled inside the kitchen and was slowly dying.
She called and held him while she waited for the ambulance. The client began to operate in survival mode and avoided thinking about her loss. But sirens became a trigger for her. When she heard them, she would run to a bathroom and cry.
So, Rookey decided to use in vivo exposure to help the client retrain her body and mind to get to a healthy state again. First, Rookey asked the client, who worked near a hospital, to step outside whenever she heard an ambulance and listen to the sirens while engaging in calming activities such as deep breathing.
After the ambulance passed, the client would repeat positive affirmations e. This slowly exposed the client to the trigger in a safe way. After the client was comfortable hearing the sirens outside her work, Rookey had the client record herself recounting the traumatic incident as if she were reliving it, and she replayed this recording every day.
In session, Rookey asked the client what parts of the story affected her most. They worked together to reframe the event to help the client realize she was not responsible for the death: Her partner always stayed up late and smoked a cigarette before bed.
She had called for help. There was nothing else she could have done. Creating new meanings. What makes a loss traumatic is not only the way the person died but also the meaning attached to the death, Oliver says.
The son had been struggling with a drug addiction for a decade, but the night before he died from suicide, they had had a fight and the mother had said some unkind things.
She blamed herself for his death. Postmortem autopsies reveal that these individuals have 1, times the cortisol in the brain, and other systems such as the HPA [hypothalamic-pituitary-adrenal] axis, receptors and neurotransmitters are not functioning normally. That means they do not have access to the prefrontal cortex, the reasoning part of the mind. That information comforted the client.
Finding a way forward. After mitigating the trauma of their loss, clients are ready to take a step forward. The exercise encourages them to think about their future and gives them some meaning as they start down this new path, she says. That might include being more involved with their families, developing a greater appreciation for life or even embracing new opportunities that emanate directly from the traumatic event.
This is when counselors could encourage — but not push — clients to continue their transformation process from the sense-losing free fall to a sense-remaking journey, Dickonson advises.
Counselors should also be mindful that when clients come out of the grief abyss, they may replace their grief with another unhealthy coping behavior, she cautions. So, counselors have to continue to support clients as they start this journey forward. Rookey and her client who lost his stepfather and mother all before he turned 21 had to address his negative beliefs about his responsibility in their deaths before he could find a way to move forward and grieve in a healthy way. These were small steps toward him carving out his new identity and moving forward on his parallel path.
Lindsey Phillips is the senior editor for Counseling Today. Children might be preoccupied with worries about other people dying, or themselves dying. Older children understand the permanence of death, and may feel life is unfair, why did this happen to me?
They may be extremely sad or angry, have sleeping and eating problems, and difficulty concentrating which are all typical of adult mourning. Many children, even from a young age, may worry that they were somehow responsible or contributed to the death of the person they loved, or that they could have prevented them from dying, which adds considerably to their distress. Being able to mourn successfully, which means being able to move forward with life, is a complicated process. A child has to be able accept the loss which means tolerating the pain of the loss when thinking about the person who has died.
A child must also be able to tolerate the guilt or regret or anger about things said or done in the relationship that can never be unsaid or undone. Many experts say that the loss of a parent by any means during childhood is traumatic but whether that trauma leads to traumatic grief such that the child is unable to mourn and unable to move on with life, depends on many factors.
Being unable to say goodbye, witnessing a violent death, shame or self-blame such as in a suicide, are all situations that could contribute to a child experiencing traumatic grief. When children experience traumatic grief they may experience intense fear and helplessness, have horrifying recollections of the event, nightmares and other panic symptoms, or they may put all their energy into avoiding thoughts and feelings about the death, become numb, unable to recall details of the event, and feel detached from activities and people.
The more trauma symptoms a child experiences, and the longer they persist, the less the child is able to mourn. Sometimes, when a child loses a parent, he or she loses both parents.
Children do better when the surviving parents are better able to cope, and when there are close extended family members who can step in and provide support. And someone needs to help the surviving parent. Mothers who are able to manage their stress and grief, and adapt to their new roles and communities have children who manage and adapt, as well.
Mothers who are depressed or anxious, living in the past, or unable to adapt are more likely to have children who struggle. Probably, both are important. Typically, children who are grieving are distressed for periods of the day but they are also able to play and to engage with friends and activities during other periods of the day. They cry and have anger outbursts but they also laugh. They may have trouble sleeping or concentrating but those difficulties tend to subside after a month or so.
They usually want to talk about the person who died, to ask questions, and to participate in memorializing that person by creating a scrapbook or planting a shrub.
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