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Treating Traumatic Bereavement: A Practitioner’s Guide PDF

378 Pages·2014·5.531 MB·English
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ebook THE GUILFORD PRESS TreaTing TraumaTic BereavemenT Treating Traumatic Bereavement A PrActitioner’s Guide Laurie Anne Pearlman Camille B. Wortman Catherine A. Feuer Christine H. Farber Therese A. Rando THe guiLFOrD PreSS new York London © 2014 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The Publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for clinical use. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Pearlman, Laurie A. Treating traumatic bereavement : a practitioner’s guide / Laurie Anne Pearlman, Camille B. Wortman, Catherine A. Feuer, Christine H. Farber, Therese A. Rando. pages cm Includes bibliographical references and index. ISBN 978-1-4625-1317-8 (pbk.) 1. Bereavement—Psychological aspects. 2. Post-traumatic stress disorders—Treatment. 3. Sudden death—Psychological aspects. 4. Death—Psychological aspects. 5. Grief therapy. I. Title. RC455.4.L67P43 2014 616.85′21—dc23 2013022787 To those individuals who have endured the sudden, traumatic death of a loved one and to the therapists who commit to helping them About the Authors Laurie Anne Pearlman, PhD, is a clinical psychologist and independent trauma consultant based in western Massachusetts. She is a member of the Complex Trauma Task Force of the International Society for Traumatic Stress Studies, a Fellow of Division 56 (Trauma Psychol- ogy) of the American Psychological Association (APA), and cofounder of the Traumatic Stress Institute/Center for Adult & Adolescent Psychotherapy. She has received awards for her clinical and scientific contributions from the International Society for Traumatic Stress Studies and the Connecticut Psychological Association, and for contributions to professional practice from APA Division 56. Camille B. Wortman, PhD, is Professor of Psychology at Stony Brook University in New York. Her research focuses on how people react to the sudden, traumatic death of a loved one. She is a recipient of the Distinguished Scientific Award for an Early Career Contribution in Psychology from the APA, and a joint award from the APA Science Directorate and the National Science Foundation recognizing the achievements of women in science. She has authored four books and over 100 articles and book chapters. Catherine A. Feuer, PhD, is a cognitive-behavioral psychologist in private practice in St. Louis, Missouri. Her clinical work, research, and publications are in the areas of anxiety disorders and posttraumatic stress disorder. She was formerly a postdoctoral fellow and Assistant Research Professor at the Center for Trauma Recovery at the University of Missouri, St. Louis. In her private practice, she treats trauma clients, including survivors of sudden, traumatic loss. Christine H. Farber, PhD, is a clinical psychologist based in central Connecticut, where she practices psychological consultation informed by her interests in archetypal and humanistic psychology. She is Adjunct Professor at the University of Hartford’s Graduate Institute in Pro- fessional Psychology and serves on the board of directors of the Connecticut Psychological Asso- ciation, which has honored her with numerous awards. Therese A. Rando, PhD, is Clinical Director of The Institute for the Study and Treatment of Loss in Warwick, Rhode Island, which provides psychotherapy, training, supervision, and con- sultation. She is a diplomate of the American Academy of Experts in Traumatic Stress (Board Certified Expert in Traumatic Stress and Board Certified in Bereavement Trauma). A recipient of numerous professional awards, she is the author of over 80 works, including How to Go On Living When Someone You Love Dies, Treatment of Complicated Mourning, and Coping with the Sudden Death of Your Loved One: A Self-Help Handbook for Traumatic Bereavement. vi Preface In writing this book, we came together with one goal: to improve the treatment available to people who have experienced the sudden, traumatic death of a loved one. Such deaths take many forms. In some cases, the death may have come about through the deliberate actions of another, as when a young woman is murdered by her ex-boyfriend. In other cases, the mourner may have contributed to the loved one’s death, as when a father purchases a handgun that he neglects to lock up, which his teenage son then uses to commit suicide. In still other cases, the survivor experiences many profound losses in addition to the loved one’s death, as when a tornado touches down in the neighborhood. To some degree, these survivors will face different issues: Some will live in fear that another loved one may be killed, some will struggle with guilt, and some will be exposed to bureaucracy at every turn as they try to rebuild what was lost. Despite these differences in how people experience the death, these losses share two common elements: Survivors of such losses can expect to experience painful feelings of grief as well as symptoms of trauma such as flashbacks, sleep disturbances, and problems with concentration. Treatment that focuses on only one of these elements is unlikely to be effective. In this book we present a multifaceted therapy for these survivors. Our comprehensive treatment approach supports mourners in addressing both the trauma and grief associated with their losses. The treatment approach has three core components: building resources, processing trauma, and facilitating mourning. Briefly stated, the treatment will help traumatic bereave- ment clients develop the internal and external resources they need to process the traumatic dimensions of the death. The trauma processing, using cognitive-behavioral and exposure tech- niques, allows clients to address the trauma complicating their grief. Facilitating the processes of mourning enables clients to accommodate their loss. Through resource building, trauma pro- cessing, and the work of mourning in the context of a supportive relationship with their thera- pist, mourners are gradually able to adopt healthy new ways of moving forward in the world without the deceased. Who We Are And hoW This Book CAme ABouT This book is the result of a long-term, stimulating collaboration among five psychologists who share a common aim: to help people with traumatic bereavement come to terms with what has happened and, ultimately, to lead more fulfilling lives. Some of us have sudden, traumatic losses vii viii Preface in our personal backgrounds; all of us have encountered these survivors in our professional and personal lives. Their anguish and lack of treatment options motivated us to develop this approach. On many occasions, we have had the opportunity to speak with survivors of traumatic loss who were disappointed in the treatment they received. Here are four examples: 1. About a year after losing her son in an accident, a woman began seeing a therapist. After 9 months of weekly treatment, the therapist told her, “You have a lot of trauma symp- toms and I don’t know how to treat those. We can either take a break, and I will attend some trauma workshops, or I can refer you to someone else.” 2. A man whose son, a pedestrian, was killed by a drunk driver, struggled with flashbacks about what had happened that night. “My therapist advised me to stop dwelling on these thoughts, and to just put them out of my mind and try to think about something more pleasant. He implied that the problems that I had with these thoughts reflected a lack of willpower on my part.” 3. A young man lost his brother, whom he had not seen in a year, in an airplane crash that he had witnessed while awaiting his arrival at a small airport. Two years later, still plagued by images of the crash, he entered therapy. After he told the therapist that he wanted to preserve some sense of connection to his older brother, the therapist told him that he had attachment problems and required intensive psychotherapy for what obvi- ously were long-standing issues. 4. About 6 months after losing her husband in an industrial explosion, a woman made an appointment with the employee assistance person at her husband’s workplace. She showed up at the appointment with her two daughters, ages 10 and 12. As she expressed it, “I told him a little bit about what happened to Robert and he literally went running out of the room. He said that he didn’t have the training to help us. I thought he would send in someone else, but that didn’t happen.” In addition to hearing from survivors, we have had countless conversations with therapists who had a strong desire to help traumatically bereaved clients, but who were uncertain or misguided about how to do so. In some cases, it appeared that therapists were unaware of the prevalence or the intensity of trauma symptoms. Similarly, many therapists seemed to be unin- formed about the duration of these symptoms, not recognizing that following a traumatic death, debilitating symptoms of grief and trauma can last for several years. As they learned more about traumatic bereavement, some therapists conveyed concerns that in the past, they may have responded inappropriately to bereaved clients’ disclosures of traumatic experiences. Some expressed regret that they pathologized clients who displayed intense and prolonged trauma symptoms. For example, one therapist stated, “If I knew then what I know now, I would have been able to legitimize my client’s responses to his loss. This would have made a big difference.” Another therapist treated a woman whose daughter had been shot, told us that one of the most difficult aspects of the loss was what the client witnessed when she discovered her daughter’s body. “I have to admit that I had great difficulty initiating discussion around this issue. When it did come up, I told myself that we should not focus on it too long or it might destabilize my client. I can now see that my client was avoiding this topic, and I was aiding and abetting her effort to do so.” We have also reflected on our own difficulties

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