Loss and grief: Psychotherapy strategies and interventions.

Abstract

Psychotherapy strategies and interventions are provided for a variety of losses. The model presents three assessment tasks (identify and reframe the symptoms, determine the stage of grief, assess normal versus complicated grieving) and five intervention tasks (establish a therapeutic agreement, make the lost object more present, identify and facilitate expression of the emotional states, facilitate saying goodbye and link to other support systems, and monitor countertransference reactions). Interventions for a wide variety of losses are described and references for a number of specific losses are provided.Beginning with Freud's (1917) treatment of loss, grief, and depression in Mourning and Melancholia, and Lindemann's (1944) classic study on acute grief, a number of clinicians have developed models for understanding the complex cognitive, affective, and behavioral changes that occur in response to a wide variety of losses. Perhaps most impressive is the comprehensive work done by

The Adaptive Change Model: An Advance on the Transtheoretical Model of Change

“…The first stage in the process of change is Openness to Opportunity. In this stage, the individual recognizes and is consciously aware that change is possible (Cochran & Laub, 1994;Dunphy, 1993;Maurer, 1996;Prochaska, Velicer, DiClemente, & Fava, 1988;Rye, 1996) and remains flexible, open, and accepting of the possibility of change (Lamb, 1988;Rogers, 1967) and the discrepancy between the current and future state (Mithaug, 1993, Nuttin, 1984. The person practices Visualization (Spencer, 1989), imaginatively and practically creating a view of what might happen after change has occurred (Bridges, 1995;Huszczo, 1996;Miraglia, 1994) and adopting a clear nearsighted and farsighted vision (Harvard Business School, 1991;Robbins, Waters-Marsh, Cacioppe, & Millett, 1994).…”

“…Negative emotions that have been associated with change include anger, resentment, guilt, fear, anxiety, despair, and feeling out of control (Bowles, 2006). The management and alteration of negative emotions into a corrective experience of emotions is central to facilitating change (Kramer, 1990;Lamb, 1988;Rogers, 1967;Teyber, 1997;Watson, & Tharp, 1997). Social Support means a variety of supporters and coalitions that are helpful and reliable in assisting the individual who is trying to change (Ancova et al, 1996;Harvard Business School, 1991;Prochaska et al, 1988).…”

Trauma, Imagery and Focusing / Trauma, bildhafte Vorstellungen und Focusing / Trauma, evocación de imágenes y Focusing / Trauma, fantasie en Focusing

“…These therapies resemble grief therapies, with the recovery from trauma resembling the process of mourning (Bowlby, 1980;Lamb, 1988). There is also an overlap in content: a traumatic experience often involves a loss, and a loss can be traumatic as well (Jacobs, 1999).…”

Psychotherapie en vroege rouw

“…Omdat een rouwbegeleiding in dat geval te kort schiet, wordt een rouwtherapie geı¨ndiceerd geacht. De laatste twintig jaar zijn er verschillende vormen van rouwtherapie beschreven, varie¨rend van confronterend, cathartisch en openleggend tot toedekkendsteunend en directief (zie onder anderen : Lamb, 1988;Ochberg, 1988; Ramsay, 1977a en b;Stern, 1985;Wortman & Cohen Silver, 1989;Yalom, 1980Yalom, , 1988.In twee eerdere bijdragen besprak ik een rouwtherapie waarbij de confronterende en gedragstherapeutische technieken van Ramsay werden vervangen door de subtielere methode van focusing (Coffeng, 1986(Coffeng, , 1992a. Opvallend hierbij was dat het rouwproces als vanzelf weer op gang kwam, zodra clie¨nten focusing begonnen te leren, en dat het proces eerder gekenmerkt werd door kleine gevoelsverschuivingen ('experie¨ntie¨le stappen') dan door heftige emotionele ontladingen zoals we die bij de methode-Ramsay vaak tegenkomen.…”