Interventions for prolonged grief

Dr. AJ Macdonald     1

INTERVENTIONS FOR PROLONGED GRIEF Solution-focused therapists do not usually offer direct advice. However, in some circumstances, they may choose to offer strategies or ideas which others have found to be of value. In common events such as grief, there are a number of recognized options that can be tried. Some are drawn from solution-focused practice while others have been developed by different disciplines.

Introduction Losing a loved one by death or separation is followed by grief. Prolonged grief is defined as grief that is not moving through the expected stages at the expected pace or where grieving is continuing beyond the expected time period. This must be distinguished from a formal depressive illness arising from the stress of bereavement, which has identifiable symptoms and may require treatment in addition to any intervention required for the bereavement process.

According to The Compassionate Friends organization for bereaved parents (TCF; grief for a lost child is never wholly completed. This can apply to parents who lose children through adoption or separation as well as loss through death. Normal grief after the death of a pet is a maximum of three months (Keddie 1977). But if we die, our pet will not grieve for three months. We grieve according to our kind, not according to the nature of the relationship. So there is a time of grieving which we cannot shorten, although some of the techniques described may reduce our pain. Equally, we can know that one day our pain will be less. When we receive a physical injury, often that first moment is the worst that it will ever be; thereafter, even in small ways, healing and recovery are reducing the pain. Mourning follows a similar pattern.

Prigerson et al (1997) propose that ‘traumatic grief’ predicts prolonged distress. Shear et al (2005) rename this concept ‘complicated grief’, identifiable within six months of the loss by ‘a sense of disbelief regarding the death; anger and bitterness over the death; recurrent pangs of painful emotions, with intense yearning and longing for the deceased; and preoccupation with thoughts of the loved one, often including distressing intrusive thoughts related to the death’. (They devised ‘complicated grief therapy (CGT): see below.)

Prolonged grief may benefit from intervention. Also, certain individuals may benefit from the earlier intervention in the grieving process. For example, a young mother who has lost her partner may not be able to care for her children adequately unless her own distress can be reduced. Similarly, personal distress can make it difficult for counselors to practice their profession. Some of the techniques below have proved useful in both prolonged and acute grief and are offered as possibilities for appropriate situations. The list is deliberately short and to the point. In acute grief, many people do not find it easy to follow complex strategies or instructions. However, a single brief response or action may allow the pain to diminish for the time being. Initial stage In solution-focused therapy the first session will include future-focused questions such as the miracle question. With some clients who have experienced a recent loss or bereavement,