Treating Traumatic Bereavement: A Practitioner’s Guide

378 Pages·2014·5.531 MB·English

by  Laurie Anne Pearlman, Camille B. Wortman, Catherine A. Feuer, Christine H. Farber, Therese A. Rando

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
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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