GRIEF AND GRIEF COUNSELING

THIS POST IS DEDICATED TO MY WONDERFUL MOTHER WHO DIED SUDDENLY YESTERDAY OF A HEART ATTACK.  SHE WILL BE SORELY MISSED BY MANY!

Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss.

An adult may be expected to cope with the death of a parent in a less emotional way; however, it can still invoke extremely powerful emotions. This is especially true when the death occurs at an important or difficult period of life, such as when becoming a parent, graduation or other times of emotional stress. It is important to recognize the effects that the loss of a parent can cause and address these. As an adult, the willingness to be open to grief is often diminished. A failure to accept and deal with loss will only result in further pain and suffering.

Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce).

Grief counselors feel that everyone experiences and expresses grief in their own way, often shaped by culture. They believe that it is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. Some may laugh.

Grief counselors hold that one can expect a wide range of emotion and behavior associated with grief. Some counselors believe that in all places and cultures, the grieving person benefits from the support of others^. Further, grief counselors believe that where such support is lacking, counseling may provide an avenue for healthy resolution. Grief counselors believe that grief is a process the goal of which is "resolution." The field further believes that where the process of grieving is interrupted, for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, grief can remain unresolved and later resurface as an issue for counseling.

There is a distinction between grief counseling and grief therapy. Counseling involves helping people move through uncomplicated, or normal, grief to health and resolution. Grief therapy involves the use of clinical tools for traumatic or complicated grief reactions. This could occur where the grief reaction is prolonged or manifests itself through some bodily or behavioral symptom, or by a grief response outside the range of cultural or psychiatrically defined normality.

Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions, which are usually brought on by the loss of a close person (by separation or death) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence.

They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy. A common area where grief therapy has been extensively applied is with the parents of cancer patients.

Death education is education about death that focuses on the human and emotional aspects of death. Though it may include teaching on the biological aspects of death, teaching about coping with grief is a primary focus. A specialist in this field is referred to as a thanatologist.

Crying is a normal and natural part of grieving. It has also been found, however, that crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful. Responses or actions in the affected person, called "coping ugly" by researcher George Bonanno, may seem counterintuitive or even look dysfunctional, such as celebratory responses, laughter, self-serving bias in interpreting events. Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience. Science has found that some healthy people who are grieving do not spontaneously talk about the loss and pressing people to cry or retell the experience of a loss can be harmful. Genuine laughter is healthy.

The four trajectories are as follows:

• Resilience: "The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning" as well as "the capacity for generative experiences and positive emotions."
• Recovery: When "normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or Posttraumatic Stress Disorder (PTSD)), usually for a period of at least several months, and then gradually returns to pre-event levels."
• Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.
• Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.

Five stages theory

The Kübler-Ross model, commonly known as the five stages of grief, is a theory first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying. The theory describes in five discrete stages a largely untested, but popular process by which people deal with grief and tragedy. Such events might include being diagnosed with a terminal illness or enduring a catastrophic loss. The five stages are denial, anger, bargaining, depression, and acceptance.

The theory holds that the stages are a part of the framework that helps people learn to live without what they lost. Lay people and practitioners consider the stages as tools to help frame and identify what a person who's suffered a loss may be feeling. The theory holds that the stages are not stops on a linear time line of grief. The theory also states that not everyone goes through all of the stages, nor in a prescribed order. In addition to the five-stages theory, Kübler-Ross has been credited with bringing mainstream awareness to the sensitivity required for better treatment of people who are dealing with a fatal disease.

The stages model, which came about in the 1960s, is a theory based on observation of people who are dying, not people who experienced the death of a loved one. This model found empirical support in a study by Maciejewski et al. The research of George Bonanno, however, is acknowledged as inadvertently debunking the five stages of grief because his large body of peer-reviewed studies show that the vast majority of people who've experienced a loss do not grieve, but are resilient. The logic is that if there is no grief, there are no stages to pass through.

Physiological and neurological processes

fMRI scans of women from whom grief was elicited about the death of a mother or a sister in the past 5 years found it produced a local inflammation response as measured by salivary concentrations of pro-inflammatory cytokines. These were correlated with activation in the anterior cingulate cortex and orbitofrontal cortex. This activation also correlated with free recall of grief-related word stimuli. This suggests that grief can cause stress, and that this is linked to the emotional processing parts of the frontal lobe.

Among those bereaved within the last three months, those who report many intrusive thoughts about the deceased show ventral amygdala and rostral anterior cingulate cortex hyperactivity to reminders of their loss. In the case of the amygdala, this links to their sadness intensity. In those who avoid such thoughts, there is a related opposite type of pattern in which there is a decrease in the activation of the dorsal amgydala and the dorsolateral prefrontal cortex.

In those not so emotionally affected by reminders of their loss, fMRI finds the existence of a high functional connectivity between the dorsolateral prefrontal cortex and amygdala activity, suggesting the form regulates activity in the latter. In those who had greater intensity of sadness, there was a low functional connection between the rostal anterior cingulate cortex and amygdala activity, suggesting a lack of regulation of the former part of the brain upon the latter.

Risks

Bereavement, while a normal part of life, carries a degree of risk when severe. Severe reactions affect approximately 10% to 15% of people^. Severe reactions mainly occur in people with depression present before the loss event. Severe grief reactions may carry over into family relations. Some researchers have found an increased risk of marital breakup following the death of a child, for example. Others have found no increase.

Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. Colin Murray Parkes in the 1960s and 1970s in England noted increased doctor visits, with symptoms such as abdominal pain, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al. found a five times greater risk of suicide in teens following the death of a parent. 

Complicated grief

The existence of "complicated grief" is a current debate in the field. An attempt is being made to create a diagnosis category for complicated grief in the DSM-V. Critics of including the diagnosis of complicated grief in the DSM-V say that doing so will make a natural response a pathology and will result in wholesale medicating of people who are essentially normal.

Shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions.

Professional support

For a lot of people, no professional support is needed. Some people, however, may decide to seek additional support from licensed psychologists or psychiatrists. Grief counseling, professional support groups or educational classes, and peer-led support groups are support resources available to the bereaved. In the United States, local hospice agencies may be a first contact for those seeking bereavement support. ~ WIKIPEDIA