VA Psychology Leadership Conference

1. VA Psychology Leadership Conference VA

2. My special thanks to…

3. Family Perspectives on Coping with LossGerald P. Koocher, Ph.D., ABPPSimmons College, Boston, MA VA Psychology Leadership Conference  VA

4. The Animal Model for Bereavement Research

5. The Insect Model for Bereavement Research

6. Family Bereavement ProjectPreventive Intervention Following a Child’s Death Supported by National Institute of Mental Health Grant No. R01 MH41791 Gerald P. Koocher, Ph.D. Principal Investigator and Beth Kemler, Ph.D. Co-Principal Investigator

7. Typical loss of social support over time following a loss event Week 1 Meansocialsupport Perceivedsocial support Week 6 Time elapsed since death

8. Patterns of family interaction following a death • External social support rises sharply after the loss event and then declines • Intra-familial support can be variable Congruence Complementary Mutual Escape Distancer and Pursuer

9. Understanding Basic Tasks of Mourning • Accepting the reality of the loss • Grieving: experiencing the pain and emotion associated with the loss • Adjusting to the new reality • Commemoration: relocating representation of the deceased in one’s own life

10. Avoid parallel service delivery; partner with medical team. Focus on family intervention whenever possible. Normalize the family’s distress. Suggest active coping strategies; providing sense of control. Engage around common fears and attributions Pay attention to symptom relief. Fundamental Intervention Strategies

12. Strategies for Helping Children Cope • Find out what the child already knows. • Anticipate the child’s fears. • Correct misconceptions. • Give clear information. • Invite questions and participation.

13. Children’s Unasked Questions • Did I make that happen? • Is it my fault? • Is that going to happen to me? • Is it going to happen to someone else I care about? • Who will take care of me?

14. Unique Phenomena inPre-Operational Thinking • Imminent Justice • Bad things happen as the result of bad behavior or bad thoughts • Limited perspective-taking skills • Inability benefit from another’s viewpoint or experiences

15. Adolescents’ Issues-- Hey, Grandpa, is deathbed one word or two?

16. What factors mediate the mourning process? • The nature of the loss event • Pre-existing relationships • Rituals • Functioning of survivors • Family and community influences (social support systems) • Individual characteristics

17. Exploring the loss event (sharing perspectives) Discussing loss histories (families of origin) Circular questioning about coping Bibliotherapy Discussing objects of remembrance Letter writing Understanding attributions Commemoration Family coping planning Therapeutic Family Activities

18. Model Intervention Session I: Understanding each other’s loss experience • Part I – 90 minutes • Family members tell their stories • Assure that all speak for themselves • Exploration of coping • Circular questioning about perceptions of self and others • Education about grief • Child versus Adult patterns

19. Session I: Understanding each other’s loss experience • Part I – 90 minutes (continued) • Acknowledge pain and discomfort of discussing the loss again • Give parents reading material • The Bereft Parent (Schiff) • Assign Homework for Session II • Each family member to choose memory object for next session, but avoid discussing the choice at home.

20. Session I: Understanding each other’s loss experience • Part II: parents only- additional 30 minutes • Explore dyadic issues • Sources of tension in the relationship (e.g., sexual disruption, replacement child, etc.) • Discuss losses in family of origin context • How were you taught to deal with loss? • Review personal loss histories • What important losses have you suffered previously?

21. Session II: Making contact with the emotional loss • Part I: parents only - first 30 minutes • Explore interval since first session • Address any recent concerns • Normalize the distress of reawakening grief • Provide encouragement for coping efforts made to date

22. Session II: Making contact with the emotional loss • Part II: family meeting- 90 minutes • Two Exercises: • Remembering the deceased child • Family letter writing

23. Session II: Making contact with the emotional loss • Remembering the deceased child • What reminder has each person brought? • Discuss the meaning of the item. • How is the child remembered. • Where are the reminders at home? • Assess idealization. • Are negative memories tolerated? • What has been done with the child’s room and belongings? • Explore cemetery visits. • Discuss how the family has changed.

24. Session II: Making contact with the emotional loss • Family letter writing • May be literal or figurative, written or taped. • Young siblings can draw pictures. • Goal: create emotional object to take home. • Content: • Things left unsaid • Memories shared • Unanswered questions

31. Session III:Moving on with our lives • Anticipating anniversary phenomena. • Which will be most difficult for whom? • Review normal grief and “warning signs.” • Discuss re-involvement in the world for each person. • Explore meaning-making for each person. • Philosophy of life • Hope for the future • Plan family activity outside the home.

32. Staying withdrawn from family and friends Persistent blame or guilt Feelings of wanting to die Persistent anxiety; especially when separating from parents or surviving children Unusual and persistent performance problems at work or school New patterns of aggressive behavior Accident proneness Acting as though nothing happened, or happier than normal Persistent physical complaints Extended use of Rx or non-Rx drugs and alcohol Warning Signs:When is professional help needed?

33. That which does not kill me postpones the inevitable.