Group Grief Counseling with Undergraduates

Sean Moundas, Ph.D. ~ University of New HampshireNancy Hensler, Ph.D. ~ Towson University

ACPA ~ March 29, 2011

• Introduction

• Theoretical foundation of grief counseling

• Purpose, composition, and recruitment of grief group

• Description of group structure and content

• Grief-related visualization exercise

• Discussion

Introduction

• We wanted to share this information because grief and loss will affect many of the students (and colleagues) with whom you work every day

o 30% of university students experienced the death of a family member in the past year (Balk, 1997; Balk, Walker, & Baker, 2010)

o Bereavement has been linked to poor academic performance among undergraduates (Servaty-Seib & Hamilton, 2006)

Introduction (cont'd.)

• We hope to provide some introductory information about: grief and loss, theories of grief, research on interventions with the grieving

• At an intervention level, we also wanted to share a venue that we've found to be helpful for students:

the Healing From Loss psychoeducational/support group

• While the presentation describes a group that ran at a counseling center, other campus interventions may be developed from these materialso workshop series cosponsored by your CC or Health Ctr Mental Health Unit o residence hall program that helps to advertise such a support groupo outreach letters from Dean's office to students who have experienced a loss

(identifying all campus and local resources available to them--both academic and emotional/social)

o educational program for academic advisors, organization advisors, coaches

• Loss: Real or perceived sense of the disappearance of something meaningful

• Grief: the affects and cognitions associated with loss

• Mourning: the behavioral response to loss

• Primary: the major loss (e.g., a death).

• Secondary: those losses related and subsequent to the primary loss (e.g., loss of companionship, financial security, identity, innocence and/or purpose)

• Stigmatized: Shame associated with losses that are culturally considered taboo such as those related to HIV/AIDS, suicide, homicide, sexual abuse, unemployment, homelessness, infidelity, and/or illegal activities.

• Cultural: Associated with relocation, migration or immigration. There is a feeling that community and place have vanished; loss of cultural, social and personal identity; and moreover, loss of predictability, expectations and hope.

• Uncomplicated: progressive lessening of intensity of symptoms with remittance by 6 months, increasing acceptance of death’s reality and ramifications; and gradual integration of loss.

• Complicated/traumatic: prolonged, exacerbation of grief symptoms; denial of death’s reality; and the loss remains compartmentalized. There are four types:

-delayed: postponed because the person is too overwhelmed but it is felt later.

-masked: not apparent immediately following the death but surfaces somatically or in maladaptive actions.

-chronic: prolonged grief and the bereaved is aware that the reaction is problematic.

-exaggerated: intensification of symptoms such that sadness, anger or anxiety become depression, rage or panic, respectively.

• Historically: Stage models (i.e., Bowlby, 1969; Kubler-Ross, 1969; Parkes, 1972; Sanders, 1989) viewed the grief process universally, internally, linearly, and finitely, resulting in a final stage of resolution.

• Despite their limitations, these models highlighted important grief reactions:-Denial-Anger -Bargaining -Depression-Acceptance

Worden (1982): Overlapping tasks-accept the loss’s reality,-work through the pain of grieving- adjust to an environment in which the deceased is missing-emotionally relocate the person lost and move forward.

Rando (1984, 1993): 6 R’s-Recognizing the loss, -Reacting emotionally to the separation,-Recollection of memories of the deceased,-Reexperiencing the relationship-Relinquishing old attachments and assumptions-Readjusting to an altered world, and reinvesting in new

relationships.

-Introduced the concept of STUGS, subsequent temporary upsurges of grief.

Task Models

• Building upon Cook and Oltjenbruns’ (1989) Model of Incremental Grief, the Dual Process Model (Stroebe & Schut, 1999) similarly acknowledges the necessity of:

o confrontation (“grief work”): loss-oriented

o avoidance: restoration-oriented

• Neimeyer, Burke, Mackay & van Dyke Stringer, 2010:

-incorporates a narrative retelling that focuses on personal growth and the movement between confrontation and avoidance.

-approach can be especially powerful in a group setting (e.g., “coincidancing”: meaning-making among bereaved individuals about a seemingly random event that is related to the decreased)

• Most traditional college students are members of the Millennium Generation (born between 1982-2000) and have the following qualities:

-feeling unique, closeness with parents, and being team oriented (Howe & Strauss, 2000).

• Further, they may not have the cognitive capacity to alternate between restoration- and loss-oriented capacities, and therefore need psychoeducation about the different ways one can grieve (Servaty-Seib & Taub, 2010).

• Non-traditional students may feel isolated from Millennium peers and have more restoration-oriented stressors but may have a greater ability to engage in both aspects of the dual process model of coping (Servaty-Seib & Taub, 2010).

• Research has shown that friends often do not know how to respond and can be unempathic (Servaty-Seib & Taub, 2010).

• To provide a time and space for students managing the loss of a loved one to gather additional coping strategies, share with others about their loss, and connect with those who have had similar experiences

• conceived as a mixture of psychoeducation and process/support group: advertised as workshop series vs. therapy group

• Open to all students, faculty and staff

• Students whose loss was known to the university were sent letters

• The group consisted of several undergraduate students and two older staff members.

• There was also racial (2 African-American students, 4 European-American students), sex (1 male student), religious (Christian and non-affiliated students) and SES diversity (a mixture of working and middle class individuals).

• 4 sessions

• met once per week at Counseling Center

• 60-minute sessions

• co-facilitated by 2 counselors

• Resources (5-10 minutes) -Provide resources and handouts for the day -Instruct members to bring in more for others

• Education (10-15 minute lectures)

• Discussion/Process Time, with attention to group members’ loss experiences (15 minutes)

• Relaxation/Close (15-20 minutes)-Breathing-Muscle Relaxation-Visualization: Safe Space

• Session 1: Common Reactions to Loss • What is Grief; How Long Will I Grieve?; Grief Myths/Facts; Healthy Ways to Mourn

• Session 2: Social Support• Unhelpful Responses; Helpful Responses; How to best receive support

• Session 3: Contexts of Grief: Cultural & Religious/ Spiritual

• Cultural traditions for grieving; religious/spiritual beliefs/practices for coping with loss

• Session 4: Complicated Grief/Benefits of more treatment

• Complicated/Traumatic Grief and challenges for recovery

• Balk, D. E. (1997). Death, bereavement, and college students: A descriptive analysis. Mortality, 2, 207-220.

• Balk, D., Walker, A., & Baker, A. (2010). Prevalence and severity of college student bereavement examined in a randomly selected sample. DeathStudies, 34, 459-468.

• Boss, P. (2006). Loss, trauma and resilience. New York: Norton.

• Bowlby, J. (1969), Attachment and loss, Vol. 1: Attachment. New York: BasicBooks.

• Calhoun, L.G. & Tedeschi, R.G. (1999). Facilitating posttraumatic growth: a clinician’s guide. Mahwah: Lawrence Erlbaum Associates, Inc.

• Cook, A. S., & Oltjenbruns, K. A. (1989). Dying & grieving: Lifespan & family

perspective. New York: Holt, Rinehart and Winston, Inc.

• Gillies, J. & Neimeyer, R.A. (2006). Loss, grief and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31-65.

• Howe, N.. & Strauss, W. (2000). Millennials Rising. Vintage Books.

• Humphrey, K.M. (2009). Counseling strategies for grief and loss.

Alexandria: American Counseling Association

• Kubler-Ross , E.(1969). On Death & Dying. New York: Simon &

Schuster/Touchstone.

• Malkinson, R. (2007). Cognitive grief therapy: Constructing a rationalmeaning to life following loss. New York: Norton.

• Neimeyer, R.A., Harris, D.L., Winokuer, H.R. & Thornton, G.F.

(2011, in press). Grief and bereavement in contemporary society:

Bridging research and practice. New York: Taylor and Francis.

• Parkes, C.M. (1972). Bereavement: Studies of grief in adult life. New

International Universities Press.

Resources Rando, T.A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Champaign, IL:

Research Press.

Rando, T.A. (1993) Treatment of complicated mourning. Champaign, IL: Research Press.

Sanders, C. (1989). Grief: The mourning after. New York: Wiley.

Servaty-Seib, H. L., & Hamilton, L. A. (2006). Educational performance and persistence of bereaved college students. Journal of College Student Development, 47, 225-234.

• Servaty-Seib, H.L. & Taub, D.J. (2011). Bereavement and college students: The role of counseling psychology. The Counseling Psychologist, 38,947-975.

• Stroebe, M. & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224.

• Walter, T. (2005). What is complicated grief? A social constructionistperspective. Omega, 52, 71-79.

• Worden, J.W. (1982). Grief counseling and grief therapy: A handbook for the mental health professional. New York: Springer.

• Worden, J.W. (1982). Grief counseling and grief therapy: A handbook for the mental health professional (2nd ed.) . New York: Springer.