Clinicians Offering Supportive Interventions a Term Paper

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The first on the recommended list is that the physician must acknowledge the grief that the person is feeling, and also acknowledge the fact that he, himself, may not know what the bereaved person is going through at that particular moment. He can directly express sympathy for the bereaved family, and he can talk freely about the deceased, and mention his name too, when talking about him. He can elicit questions about the exact circumstances in which the death had occurred, and he can ask direct questions about how the bereaved feels, and what he thinks about the death and how it has affected him. The don'ts to be followed by the physician or clinician are that the clinician must never adopt a casual or passive attitude, like for example, saying, 'call me if you want to talk'. He must also learn never to make statements that what happened was for the best, and so on, and he also must never assume that the bereaved person is strong, and will therefore perforce get through the entire episode of grief quickly. He must never avoid talking about the deceased person, especially if the bereaved demonstrates a willingness to talk about it. (Managing Grief after Disaster)

William Worden has created a 'Four Tasks of grief Model'. The model is to be used by a recently bereaved or a traumatized individual who has recently suffered a great loss of some kind, to help him to deal with his grief in an active manner. 'Task One' according to Worden, is to accept the reality of the loss that has befallen the bereaved. Task Two is to thereafter, work through the pain and trauma of the grief. Task Three is to learn to adjust to a different sort of environment, and to a world in which the dear loved one is no longer alive. Task Four, according to Worden, is to emotionally relocate the deceased, and then, move on with his own life. (J William Worden's Four Tasks of Grief Model)

In general, a person who has recently suffered a tragedy or trauma turns to metaphors in order to deal with the grief in a better manner. Metaphorizing would also help the individual to understand, and then to express their experience better. Some examples of where a metaphor is used to describe grief: 'grief is a whirlwind', 'grief is a Great Depression all over again', and 'grief is gray, cloudy and rainy weather'. The clinician who provides intervention for the bereaved and grief-stricken person can in fact enhance his bereavement efforts by making serious attempts to learn to identify and thereafter to cultivate such metaphorical expressions of grief, from the families and others involved. (VandeCreek, 2005)

It is interesting to note that until recent times, it was believed that everyone inevitably goes through the very same sequences of recovery from grief, and at an average, the same speed too. Any departures from the pattern of mourning, or the length of the grieving period were taken to be the indicators of pathological grief. Furthermore, the idea that the bereaved individual would eventually try to strike out on an entirely new life, different from his old one, were never highlighted in these older grief models. Recently, however, numerous other grief models have been developed, and other Worden's four tasks of grief model, Kubler-Ross have created another, based on the various stages of accepting grief. The first stage, according to Kubler-Ross, is that of numbness. This is a stage that immediately follows the death of a loved one, and it would generally last for about seven to ten days. (the phases and Tasks of Grief Work)

Numbness refers to the sense that the person has, of disbelief and paralysis, and a sense of being far removed from what has happened, and what is happening. The clinician must remember that many people consider that this feeling of numbness is the body's own coping mechanism in the face of devastating grief, so that one may not be overwhelmed by the grief that one feels at the bereavement that has taken place. The second stage is when the bereaved feels that he has great difficulty in accepting the reality of the loss that he has had to bear. This can lead to the bereaved behaving in an irrational manner, wherein he acts as if the death had not occurred at all. The clinician must note that complete acceptance of death is a part and parcel of the process of grieving and subsequent revival.

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The third stage is when the bereaved feels an irrational anger towards the entire world, against God, against fate, and also against the remaining people in their lives. Bargaining with God for the safe return of the deceased person is also a part of this stage. The fourth stage is when the bereaved gradually starts to accept reality, and what has happened. Acceptance is the fifth and final stage of grief, and this is when the bereaved has come to terms with his loss, and is finally able to move on to re-invest and re-affirm in the life that lies ahead of him, without his loved one. (the phases and Tasks of Grief Work)

Recently, researchers, including Worden and mental health specialists have come to recognize the fact that there are four important tasks that a bereaved individual must be able to achieve, before he can fully integrate his experience of loss and the trauma associated with it, into his life, and then move on to a new life, without his beloved one. These then are the four basic tasks: he must first recognize the loss that has happened to him, even though it is a fact that he may try to minimize it or even deny it completely altogether. Once he accepts the loss, then he would be able to process it intellectually. His next task would be to release the emotions that grief and loss bring into a person's life. This may be accompanied by the myriad of emotions associated with loss: despair, sadness, anger, disbelief, and shame.

Even though these feelings may be omnipresent at first, they do fade gradually to a dull and permanent ache. The fact that grief tends to surface unexpectedly may lead people to believe that the bereaved is out of control. The third task is to develop new skills; in other words, the bereaved must try to take on new roles, and make new contacts in the world, or find a grief support group. Finally, the bereaved must be able to invest plenty of emotional energy in his present, wherein the new relationships or new contacts that he has formed would be able to derive the direct benefit. It is at this phase that the bereaved will feel that he is now, finally able to say 'farewell' to his deceased loved one. (the phases and Tasks of Grief Work)

When deciding on intervention in a crisis or a grief situation, the physician or the clinician must be careful in choosing who to treat, and who to include in the intervention process. The family and community of the bereaved must be taken into consideration, especially if it is a young person who has lost a loved one. According to Worden, children may often feel that they need to hide their complex reactions and trauma brought on by their parents' divorce, perhaps because of the existing conflict between the parents. (Roberts, 2000)

It must be remembered that research has revealed the fact that grief and a grieving situation is indeed extremely complex, and it can depend on a number of varied factors. This would therefore mean that in a case where a clinician needs to bring in intervention methods to help the individual who is grieving, the personal and the situational contexts in which the bereavement has occurred must be taken into consideration. These would thereafter be allowed to influence the treatment decision that the clinician will be making at a later date, for the bereaved. Children, middle-aged persons, young people, and the aged, all experience complex symptoms of grief, and they differ from individual to individual, and from situation to situation, and the clinician must be able to focus his efforts on the appropriate and accurate mixture of physical, mental, and social factors involved, when making a treatment plan for the patient. The better the intervention and the earlier, the quicker would be the patient's response, and the faster he would be able to get back into the mainstream of life, and overcome his grief at his loss. (Stroebe; Stroebe; Hansson, 1993)

In conclusion, it must be stated that, both conceptually as well as clinically, it is extremely important to encourage more links between trauma and grief, and thereafter, to understand the fact that there is inevitably….....

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