Catastrophic Conditions in Couple Systems

SUMMARY

A presentation of case studies forms the focus for an exploration of the discovery of an abortion or adoption used as the management of an unwelcome pregnancy which occurred in the context of the marital system. Managing an impasse in the middle phase of therapy in each case led to the emergence of information which then allowed the therapist to work with the couple system to alleviate the core situation out of which presenting problems emanated. In these cases the unwelcome pregnancy had the potential to be cataclysmic to the couple system. Therefore, the possibility that a couple is concealing an abortion or an adoption should be considered by couples' therapists when there is little or no response to usual strategies for change. The reason for concealment is immaterial. What is paramount is that the therapist bring the event to the fore of treatment and work with a couple to put closure on what is generally an unresolved issue.     

Complicated Grief: An Evolving Theoretical Landscape

The bereavement literature has proliferated in recent decades, generating a shift from conceptualizing grief as a stepwise, uniform process to an idiosyncratic experience that varies among individuals. Among the most notable developments is the empirical exploration of complicated grief—a protracted, debilitating, sometimes life‐threatening response to the death of a loved one—and the testing of novel interventions to treat it. This article provides counselors with recommendations for identifying and treating complicated grief.     

Goodbye,Daddy: An Autoethnographic Journey Through the Grief and Mourning Process

The purpose of this article is to present an autoethonographic study in how I experienced and communicated parts of the mourning process when my father died at the age of 73. The article highlights the stages of grief experienced during the first year. Autoethnographic means are used chronologically to explore how the loss of a family member impacts the stages of grief that are present and how they overlap. In particular, I highlight the events that carried meaning or provided an outlet to express one of the stages of grief. It is hoped that this article can be used to understand why grieving is not an overnight process, but rather is drawn out through the highs and lows of remembering a loved one.     

The Role of Avoidance in Complicated Grief: A Detailed Examination of the Grief-Related Avoidance Questionnaire (GRAQ) in a Large Sample of Individuals with Complicated Grief

Grief-related avoidance is a significant component of complicated grief, yet has rarely been formally measured in a validated fashion. Further, more work is needed to understand the impact of grief-related avoidance on symptom severity and functional impairment among individuals with complicated grief (CG). The Grief-Related Avoidance Questionnaire (GRAQ; Shear, Monk et al. 2007) was created to assess grief-related avoidance and the present analysis aimed to further develop this measure and construct by confirming the GRAQ’s psychometric properties and examining loss-related predictors of avoidance. In a sample of 393 adults with CG, we found the GRAQ had high internal consistency, with a Cronbach’s alpha of 0.89 and good convergent validity. While the EFA results suggest that the GRAQ may be unidimensional, a 3-factor model generally corresponded with the findings by (Shear, Monk et al. 2007), which suggested the presence of 3 subscales. Loss-related variables age, relationship to the deceased, and cause of death were all significant predictors of GRAQ scores. Our findings support that among individuals with complicated grief, avoidance is common, measurable and an important contributor to impairment.     

A Journey into Grief

The experience of the death of her Grandmother immerses the author in an intimate experience of grief. She reflects on her journey into grief and presents insights into grief's impact on her personal story as well as her professional life, i.e., her clinical work as a young psychoanalyst-in-training. Other metaphors and dream images, such as life, death, home, homelessness, silence, speech, story, voicelessness, aloneness and loneliness echo throughout the reflection as the author attempts to articulate an understanding of the profound Self-change birthed by death, grief and loss.     

Grief Therapy: An Experiential Workshop

The authors conducted a workshop at a family therapy conference in South Africa in 1997 to explore the use of healing rituals in grief work. There were two levels involved: First, an experiential workshop, and, second, a metalevel in exploring the use of rituals as a rite of passage to facilitate transitions. A draft of the authors' paper was sent to all participants for their comments, which are included in the text.     

ADHD and Grief: Diagnosis and Differentiation at One Federally Qualified Health Center

Family physicians provide medical care including diagnosis for children experiencing loss and grief. The cognitive impact of loss includes poor attention and concentration, suggestive of attention deficit hyperactivity disorder (ADHD). Our study examined this phenomenon in a community health center (CHC) utilizing physicians’ surveys and a medical record audit of 378 children diagnosed with ADHD during a three-year period. Results identified ambiguous loss and trauma resulting from family instability, absent parent, domestic violence, abuse, and foster care, often unrecognized by physicians as producing grief accompanied by attention and concentration problems. Findings suggest exploration of repeated ambiguous losses in children with ADHD.     

Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment

Grief from various losses can underlie the process of recovery from substance abuse disorders. This study identified losses that clients encountered prior to abusing substances, losses that occurred as a result of addiction, and losses that occurred upon entering treatment.     

Grief Counseling: An Investigation of Counselors' Training,Experience, and Competencies

Grief is prevalent in counseling, but little is known about the current status of counselors’ preparation and competencies to provide effective care. This exploratory study surveyed counselors (N= 369) on grief training, personal and professional experiences with grief, and grief counseling competence. Multiple regression analyses found training and experience were statistically significant predictors of competence. The strong relationship between variables suggests these concepts may be understood as synonymous. Implications for training, practice, and research are discussed.     

Eternal Connection: An Exploratory Study of the Effects of Learning About Near-Death Experiences on Adult Grief

We examined the effectiveness of a near-death experience (NDE) psychoeducational group bereavement intervention in reducing distressing aspects and enhancing a growth aspect of grief among bereaved adults. Participants were 22 females and 2 males (2 African American, 3 Asian, 2 Latina/o, and 17 White non-Latina/o) ranging in age from 20 to 71, with a mean age of 35.3 years. In this experimental design, we randomly assigned 12 participants to the experimental group and 12 participants to the waitlist control group. Effect size findings based on Hogan Grief Reaction Checklist scores indicated modest to substantial benefits of the NDE learning module intervention for bereaved adults in the form of decreased panic behavior, blame and anger, and detachment and increased personal growth. Conclusions include that further research into the effectiveness of NDE-related psychoeducational programs with bereaved individuals is warranted.     

Psychometric Properties of the Grief Cognitions Questionnaire (GCQ)

Cognitive behavioral conceptualizations of complicated grief propose that negative cognitions play a core role in the development and persistence of emotional problems after bereavement, because they generate negative emotions and cause mourners to engage in counterproductive attempts to avoid the implications and the pain of the loss. To facilitate the assessment of potentially problematic cognitions after bereavement, the Grief Cognitions Questionnaire (GCQ) has been developed—a 38-item questionnaire representing 9 categories of cognitions. Building on a previous study that supported the reliability and validity of the GCQ, the current study further examined its psychometric properties, with data of 531 bereaved individuals who completed research questionnaires online through the Internet. Confirmatory factor analyses supported the nine-factor structure with 9 interrelated factors. The reliability and convergent and discriminative validity were found to be adequate. Altogether the GCQ seems to be a useful tool for the assessment of negative thinking after bereavement in research and clinical practice.     

Yearning and Its Measurement in Complicated Grief

Persistent intense yearning for the deceased is a core clinical feature of complicated grief (CG) that distinguishes it from other mental disorders that develop following loss. The Yearning in Situations of Loss Scale (YSL) is a recently developed assessment of yearning. To assess the psychometric properties of the YSL in those with CG, we administered the YSL, Inventory of Complicated Grief, and Quick Inventory of Depression Symptomatology to 303 treatment-seeking bereaved adults with CG. Our results suggest the YSL is a reliable assessment with acceptable convergent and discriminant validity as a measure of yearning in those with CG.     

School Counselors,Multiple Student Deaths,and Grief: A Narrative Inquiry

A team of 5 school counselors were interviewed to learn how they professionally and personally experienced the deaths of multiple students in 1 year in their school while attending to the needs of the school community. By using narrative inquiry, 5 themes emerged from the analysis: gravity of the losses, logistics of care, personal vs. professional conflicts, increased student cohesion, and efficacy. Recommendations for counselor preparation, research, and counseling practice are offered.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

Disenfranchised Grief Following a Traumatic Birth

Following a “failed” birth plan, some women experience trauma. Because most of these women do end up with a healthy baby, their support system does not necessarily support the sadness felt at the loss of the dream birth experience, leading to disenfranchised grief. Comments on a Facebook post linked to an essay from the Scary Mommy website were examined. Thematic analysis revealed three overarching categories of comments: (a) grief is disenfranchised by others through nonlosses and one-upping; (b) other posters expressed camaraderie for the loss of a dream birth, expressing empathy; and, (c) conditional support.     

Divergent and Convergent Validation of the Complicated Grief Prototype Narrative

Although there is a prototype narrative for complicated grief (CG), there are neither divergent nor convergent validity studies of its clinical value. We evaluated the CG prototype narrative using a sociodemographic questionnaire and the Clinical Interview for Complicated Grief Diagnosis. We first conducted a convergent validation analysis followed by a divergent validation analysis. Results showed that participants with CG identified significantly more with the complicated grief prototype narrative than participants without CG.     

Conceptualizing an HIV Diagnosis Through a Model of Grief and Bereavement

For people living with HIV/AIDS, grief and bereavement typically refer to the loss of life felt in the HIV community. However, changes in HIV treatments allow care providers to view HIV grief in a way that considers physical, social, and emotional loss, as well as a loss of the life they had previously pictured for themselves. Kübler‐Ross's ( 1969 ) model of bereavement is presented as a way to conceptualize clients living with HIV who are dealing with grief and bereavement. In addition, popular bereavement counseling approaches relevant to clients with HIV are discussed, and a case illustration is provided.     

The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss

Recent studies have supported the distinctiveness of complicated and prolonged forms of grief as a cluster of symptoms that is separate from other psychiatric disorders. The distinction between prolonged and normal reactions to loss remains unclear, however, with some believing that prolonged grief represents a qualitatively distinct clinical entity and others conceptualizing it as the extreme end of a continuum. Thus, in this study a taxometric methodology was used to examine the underlying structure of grief. Participants included 1,069 bereaved individuals who had lost a first-degree relative. Each participant completed the Dutch version of the Inventory of Complicated Grief–Revised, which was used to create indicators of prolonged grief. The mean above and mean below a cut (MAMBAC) and maximum eigenvalue (MAXEIG) tests supported a dimensional conceptualization, indicating that pathological reactions might be best defined by the severity of grief symptoms rather than the presence or absence of specific symptoms.