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CounselingStrategiesforLoss andGriefKeren M. HumphreyAMERICAN COUNSELINGASSOCIATION5999 Stevenson AvenueAlexandria, VA 22304www.counseling.org

CounselingStrategiesforLoss andGriefCopyright 2009 by the American Counseling Association. All rights reserved. Printed in theUnited States of America. Except as permitted under the United States Copyright Act of 1976,no part of this publication may be reproduced or distributed in any form or by any means, orstored in a database or retrieval system, without the written permission of the publisher.10987654 321American Counseling Association5999 Stevenson AvenueAlexandria, VA 22304Director of PublicationsCarolyn C. BakerProduction ManagerBonny E. GastonEditorial AssistantCatherine A. BrumleyCopy EditorElaine DunnCover and Text Design by Bonny E. Gaston.Library of Congress Cataloging-in-Publication DataHumphrey, Keren M.Counseling strategies for loss and grief/Keren M. Humphrey.p. cm.Includes bibliographical references and index.ISBN 978-1-55620-246-9 (alk. paper)1. Loss (Psychology) 2. Grief. 3. Counseling. I. Title.BF575.D35H86 2009158' .3—dc222008041860

DedicationThis book is dedicated to the women who shaped me with their presence:my mother, Amy Riser Harrington Humphrey,and my maternal grandmother, Elberta Riser Harrington.And to the woman who shaped me with her absence,my paternal grandmother, Lela Marie Beller Humphrey.iii

Table of ContentsPrefaceAcknowledgmentsAbout the AuthorPart 1ixxiiixvUnique Grief and Unique GrieversChapter 1 Thinking Differently About Loss and Griefin the 21st CenturyLoss and Grief Terminology356Changing Ideas About Loss and GriefNine Critical Guidelines for ConceptualizingLoss and GriefChapter 2 Listening To and Listening For Loss and GriefTypes of Loss and GriefSelected Psychosocial FactorsListening for Clues to Loss and Griefin PsychotherapyDiagnosing Uncomplicated and ComplicatedBereavement GriefChapter 3 Two Contemporary Models of Loss AdaptationAdaptive Grieving StylesThe Dual Process ModelDifferential Grief in FamiliesPart 27192025323337374751Counseling Strategies for Loss AdaptationChapter 4 Cognitive–Behavioral and Constructivist Strategiesfor Loss AdaptationCognitive–Behavioral Strategies for Loss AdaptationConstructivist Strategies for Loss Adaptation575762

Table of ContentsManaging Repetitive Thoughts and Ruminative Coping:Three StrategiesRational Emotive Imagery for AvoidanceTelling and Retelling the Story of Obscured LossResponsibility Pies and Defense Attorneys MeetShame and GuiltLoss Experiences TimelineSystemic and Thematic Genograms With Loss and GriefEarly RecollectionsObjects of ConnectionTherapeutic Grief RitualsTherapeutic Writing for Loss: Giving Sorrow WordsCinematherapy With Loss and GriefPrescription to GrieveDecisional Balance and the Possibility of ChangeConfronting Secondary GainCreating a Resilient ImageThe 2 QuestionsBreathing LessonsMindfulness-Based Practices to Manage DistressUsing Ecotherapy Strategies for Loss and GriefClient Drawings in Grief CounselingClient-Generated MetaphorsWisdom ChroniclesBrief Homework Assignments to Promote ChangeShared ReminiscenceLoss Characterization to Address Fragmented IdentityUsing Photographs to Facilitate Meaning ReconstructionChapter 5 Emotion-Focused Strategies for Loss 6118124127130135138140141142147Respecting Client Differences in Emotional ProcessingCreate a Holding Environment for Difficult EmotionsEmotional Processing Challenges in Loss AdaptationGeneral Guidelines for Emotional Processing WithLoss AdaptationUsing a Feelings List for Grief ExperiencesChair DialoguesFocusing: Moving Deeper With Feelings to AwarenessMapping Loss and Grief: Focus on FeelingsHow My Dark Emotions Have Made Me Strong152156157166171171Chapter 6 Narrative Therapy Strategies for Loss Adaptation175Narrative Therapy TerminologyBasic Assumptions of Narrative TherapyNarrative Style Questioning and ExternalizingConversationImplementation of Narrative Practicesvi147148149176176178179

Table of ContentsChapter 7 Solution-Focused Therapy Strategies forLoss Adaptation195Basic Assumptions of Solution-Focused TherapyImplementation of Solution-Focused Therapy195196Chapter 8 Adjunctive Strategies for Loss AdaptationClient Self-CareTherapeutic MassageLabyrinth WalkingThe Nature CureTai Chi and YogaCreative ActivitiesMindfulness MeditationGrief Support GroupsChapter 9 The Counseling Professional WorkingWith Loss and Grief205205206206208208209210210213Three Essential Counselor RolesPractical Suggestions for Counseling ProfessionalsThe Person of the Counseling Professional:Know Thyself213215218ReferencesIndex221237vii

PrefaceFor years my professional colleagues and I have discussed the need for a book of counselinginterventions to supplement the theoretical literature on loss and grief. The vast majority of thisliterature centers on theoretical conceptualizations of bereavement grief and research on distincttopics (e.g., complicated grief, AIDS-related grief ) or the characteristics of distinct populations(e.g., bereaved parents, the chronically ill). Although this knowledge base is essential to ourunderstanding of loss and grief, the literature tends to falls short in consideration of the technicalaspects of intervention. Most often authors suggest a direction for therapy, such as examiningunfinished business or facilitating emotional expression, but the nuts-and-bolts descriptions ofwhat to actually do with clients in therapy are often disappointingly vague or entirely absent. Itis the old challenge of translating theory into practice, and it is the reason for this book.The purpose of Counseling Strategies for Loss and Grief is to describe a range of counselingstrategies appropriate to the treatment of loss and grief issues in diverse psychotherapy settings.It is based on contemporary understandings on the nature of personal and interpersonal loss andthe ways in which people attempt to integrate loss and grief into their lives. The suggestedstrategies incorporate constructs and procedures from a wide variety of sources, reflecting bothtime-tested counseling strategies and more recent innovations in counseling theory and practice.Five themes guide this text.1. Loss and grief are frequently encountered issues in psychotherapy that are inclusive ofboth death-related and nondeath-related circumstances. Despite substantial attentiongiven to bereavement grief, nondeath-related losses just as often present significantchallenges in the lives of clients. “All changes involve loss, just as all losses requirechange” (R. A. Neimeyer, 2000a, p. 5).2. The experience of loss and grief is highly individual and intensely personal, reflecting aunique interaction of person, loss event, and the multiple contexts in which that loss andgrief occur.3. The boundary between death-related and nondeath-related loss is permeable so thatknowledge associated with each assists understanding of the other. Differences betweenthe two have less to do with the fact of death and bereavement and more to do with theuniqueness of an individual’s response to loss and his or her particular grieving journey.4. The natural extension of appreciating the uniqueness of each person’s experience of lossand grief and her or his particular manner of adapting to loss is the importance of tailoringcounseling strategies to client needs. If the experience of loss and grief is unique, thencounseling interventions that address those experiences must prioritize that uniqueness.ix

Preface5. It is assumed that counseling professionals regard the strategies described here, like anytherapeutic intervention, as inherently adaptable. Sound theoretical conceptualizationand a solid working relationship precede selection of interventions, which are thencustomized to fit the unique needs of clients and the evolving counseling process.Perhaps it is useful here to point out what this book does not attempt to do. It is not intendedas a comprehensive treatment manual in which a set of prescribed interventions from astandardized theory are applied invariably to every client, family, or group. There is no laundrylist of goals and objectives from which to pick and choose and no stereotypical list of culturalcharacteristics that obscures individuality. Instead, this book describes a broad range of counselingstrategies that are adaptable across various theoretical orientations and includes practicalsuggestions for increasing their effectiveness.Whom This Book Is ForCounseling Strategies for Loss and Grief is intended primarily for counseling professionals andclinical supervisors working in diverse psychotherapy settings. It also provides a valuable, practicalresource for graduate trainees in counseling and counseling-related professions, where issues ofloss and grief are inadequately addressed (Humphrey, 1993). The counseling strategies outlinedhere are most appropriate for adolescents and adults and are primarily aimed at individualtherapy situations. However, suggestions for using these strategies in group and family therapysettings are provided. Additional resource recommendations specific to certain topics are alsoincluded throughout the text.Terminology in This BookSometimes the terminology associated with professional psychotherapy services can be confusing,so the following clarifications apply in this text: Counseling and therapy refer to psychotherapeutic intervention services provided byqualified mental health professionals. No distinction is made in this text betweencounseling and therapy as long as services are delivered by a qualified mental healthprofessional. A qualified mental health professional possesses at least a master’s degree in counseling or acounseling-related field (e.g., psychology, social work) and national certification or statelicensure. Counseling professional, therapist, counselor, and psychotherapist areinterchangeable terms describing qualified mental health professionals. Grief counseling and grief therapy refer to psychotherapeutic interventions involving bothdeath-related and nondeath-related grief. Strategies is the preferred term for counseling interventions described in this book. Theword techniques implies something done to clients by counselors without input fromclients, whereas strategies suggests a more respectful and collaborative therapeutic activity,tailored to the uniqueness of clients, that is consistent with effective counseling for lossand grief.

PrefaceOrganization of the BookCounseling Strategies for Loss and Grief includes two parts. Part 1, Unique Grief and UniqueGrievers, orients readers to current thinking about loss and grief and the implications forprofessional counseling practice. Chapter 1 summarizes the shift from traditional to contemporarygrief models in the form of guidelines for conceptualizing loss and grief. Chapter 2 highlightsdiverse aspects of loss and grief that merit special attention by counseling professionals. Chapter3 outlines two contemporary grief models—adaptive grieving styles and the dual processmodel—with suggestions for using these models to enhance counseling services with grievingclients. Part 2, Counseling Strategies for Loss Adaptation, offers detailed descriptions of variousinterventions appropriate in counseling for issues of loss and grief, distinguishing them by focusor theoretical origins. Chapter 4 provides strategies that focus on cognitive and behavioralinterventions, drawing largely from cognitive–behavioral and constructivist therapy models.Chapter 5 provides strategies that focus primarily on emotional processing. Chapters 6 and 7offer strategies derived from two contemporary therapies arising from postmodern andconstructivist thinking: narrative therapy and solution-focused therapy. Chapter 8 describes anumber of recommended adjunctive activities that are especially beneficial to grieving clients,their adaptation to loss, and the counseling process. Finally, Chapter 9 addresses the challengesof working with loss and grief for the counselor as a person and a professional.xi

AcknowledgmentsIt has been my good fortune to work directly or indirectly with grieving people in a variety ofsettings over several careers. I remain in awe of those individuals and families who willinglyshared their dying and their grief with me so many years ago in my first career as a parish minister.This book began with you.I am deeply grateful for the clients, supervisees, and students who have taught me so muchabout doing and teaching psychotherapy. You convinced me this book was necessary.I thank my friends and professional colleagues for their contributions and encouragement,especially Cathie Barrett, Don Combs, Deb Davis, Liz Doughty, Phyllis Erdman, Sue Metzger,Jan Pattis, and Linda Osborne.I acknowledge my American Counseling Association editor, Carolyn Baker, whose patience,good humor, and professionalism are deeply appreciated.My family is always a reliable source of support, especially my stepchildren Patti and Mike,who must have wondered if that darn book would ever be done.I acknowledge my writing partner, Chief the Black Lab, the ultimate practitioner of mindfulattention, who reminds me that long hours at the computer must be balanced with regularFrisbee and cookie breaks.Finally, I express my deepest thanks to my husband, Jim, whose sustaining love and unwaveringsupport for my endeavors so brighten and bless my life. Our life together is a wonderfuladventure.xiii

About the AuthorKeren M. Humphrey, EdD, NCC, LPC, LCPC, has more than 25 years experience inthe helping professions as a parish minister, probation officer, professional counselor, andcounselor educator. In addition to a private psychotherapy practice, Dr. Humphrey hasprovided counseling, supervision, and consultation services in the corrections field and oncollege campuses. A popular national and international presenter on grief counsel